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Author: 


Binder,  Rudolph  Michael 


Title: 


Health  and  social 
progress 

Place: 

New  York 

Date: 

1920 


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Binder,  Rudolph  Michael, 

Health  and  social  progress  by  Rudolph  M, 
•••  New  York,  Prentice- Hall,  1920. 

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Bibliography:  p.  287-291. 


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LIBRARY 


School  of  Business 


HEALTH  AND  SOCIAL 

PROGRESS 


BY 


RUDOLPH  M.  BINDER,  PH.D. 

Professor  of  Sociology, 
New    York    University 


New  York 

PRENTICE-HALL,  INC. 
J920 


CorvBiGBT.  1920 

Bt  prentice-hall.  Im. 


A  NON-MEDICAL  BOOK 

Dedicated  to  the  Medical  Profession 

The  only  one  which  has  never  used  its  knowledge  for 
inflicting  wounds  on  Mankind,  but  always  for  healing 
them;  and  is  now  to  an  ever-increasing  extent  applying 
that  knowledge  to  the  prevention  of  disease  and  the 
promotion  of  Health  and  Happiness. 


3^1 


<w* 


Man's  rise  from  the  level  of  the  animal  to  that  of 
a  civilized  human  being  has  been  due  chiefly  to  his 
own  efforts.  While  he  depended  on  nature  at  first, 
owing  to  his  limited  intelligence,  he  rose  higher  in  pro- 
portion as  he  used  his  mind  in  making  it  his  servant. 
Proofs  to  this  effect  are  accumulating  every  day.  Qi- 
mates  which  were  deadly  once,  are  now  becoming  fruit- 
ful places  for  his  enterprise.  Fears  which  once  terrorized 
him  have  been  relegated  into  the  realm  of  superstition. 
Diseases  which  once  were  deemed  unavoidable  now  yield 
to  scientific  treatment.  In  the  air  and  in  the  water,  from 
the  Arctic  to  the  Antarctic,  from  the  cradle  to  the  grave, 
he  becomes  increasingly  the  master  of  nature  and  of 
his  own  fate. 


CONTENTS 


CBAriBK 


Preface 


rAGB 

1 


PART  I 

I.    Introduction 3 

II.     Meaning  of  Health 15 

III.  Health  and  Religion 32 

IV.  Factors  of  Health 43 

V.    Health  and  Civilization    ....  53 


PART  II 

VI.    Health  and  Ancient  Greece    ...  81 

VII.     Health  and  Ancient  Rome       .       .       .  106 
VIII.    Effects  of  III  Health  on  the  Classical 

World   ........  Ill 

IX.     Health  and  the  Tropics    ....  124 

X.    Health  and  World- Progress    .       .       .  142 

XI.     Health  and  World- Progress  (Continued)  178 

XII.     Health  and  World- Progress  (Concluded)  208 

XIII.  Health  and  Originality    ....  241 

XIV.  Results  and  Prospects       ....  272 
Index 293 


PREFACE 

The  population  of  the  earth  in  1800  was  approximately 
600,000,000;  in  1900,  it  was  about  1,600,000,000— an  in- 
crease of  nearly  270  per  cent.  If,  during  the  twentieth 
century,  there  should  be  a  similar  increase — ^and  the  indi- 
cations are  all  in  that  direction— the  population  in  the 
year  2000  will  be  about  4,320,000,000.  The  question 
arising  then  will  be.  Where  shall  we  get  food? 

The  time  will  not  even  then  have  arrived  when,  accord- 
ing to  Fourier,  our  scientists  will  be  able  to  turn  the 
rocks  of  our  mountains  into  bread  and  cakes,  or  the 
brine  of  the  oceans  into  most  delicious  lemonade.  The 
question  will  have  to  be  faced  in  a  matter-of-fact  way 
instead  of  dreaming  about  it  in  a  romantic  fashion. 

Roughly  speaking,  two  forms  of  answers  have  been 
given— that  of  the  pessimist  and  that  of  the  optimist. 
Among  the  pessimists  we  may  reckon  all  those  whose 
profession  or  attitude  compels  or  inclines  them  to  look 
backward.  They  have  paid  a  heavy  price  for  doing  so, 
since  no  one  can  look  into  the  past  constantly  without 
getting  a  wry  neck  and  having  his  thought  twisted.  These 
people  gloomily  predict  an  increasingly  more  severe 
struggle,  since,  if  it  is  only  with  the  utmost  difficulty  that 
the  present  population  maintains  itself,  what  must  happen 
if  the  population  is  nearly  three  times  as  large?  Civiliza- 
tion will  be  doomed,  or  be  confined  to  a  few  favored 
spots ;  anarchy  will  prevail,  and  the  second  state  of  man- 
kind will  be  infinitely  worse  than  the  first,  because  men 
have  learned  how  to  do  more  harm  than  ever  before. 
The  optimist  believes  in  human  nature.    He,  too,  looks 

i 


u 


PREFACE 


backward,  but  his  eye  is  not  glued  to  the  past.  True, 
things  are  bad;  but  the  study  of  the  past  has  taught 
him  that  they  were  worse  before. 

Man  has  not  only  evolved,  he  has  developed.  His 
struggles  in  the  past  have  taught  him  the  all-important 
lesson  of  cooperation.  He  is  not  dismayed  by  a  growing 
population,  because  he  finds  that  men  in  1900  are  better 
fed  and  clad,  more  sympathetic  and  helpful  to  each  other 
than  they  were  in  1800.  Density  of  population  is  a 
purely  relative  term.  There  were  never  more  than 
1,000,000  Indians  in  the  territory  now  occupied  by  the 
United  States.  Yet,  the  few  Indians  found  the  land  too 
small,  and  waged  constant  wars  for  hunting  grounds. 
The  hundred  million  Americans  are  on  the  whole  satis- 
fied, and  engage  only  in  wars  of  words  about  the  best 
methods  of  improving  things. 

The  optimist  believes  with  good  reason  that  with 
increasing  intelligence  and  good  will,  problems  will  be 
solved  as  they  arise.  But  more  than  that.  He  tries  to 
shape  events  in  such  a  manner  that  they  shall  produce 
certain  results.  And  he  points  to  the  achievements  of 
man  in  the  past  and  present,  and  confidently  hopes  that 
more  will  be  accomplished  in  the  future. 

In  other  words,  the  difference  is  that  between  the 
believer  in  the  supremacy  of  natural  law  and  the  student 
of  it  for  the  purpose  of  utilizing  it.  The  animal  and  the 
savage  are  subject  to  natural  law,  civilized  man  has 
liberated  himself  from  it  to  a  considerable  extent  by 
studying  it.  And  he  hopes  that  with  a  more  intimate 
knowledge  of  nature  he  will  construct  a  social  system 
and  build  up  a  civilization,  which  will  be  able  to  support 
a  very  much  larger  population  in  a  better  manner  than 
at  present. 

Man  has  always  conquered  when  he  has  gone  to  work 


PREFACE 


••• 
m 


intelligently  and  persistently  about  a  problem.    Only  when 
he  believed  that  some  natural  force  was  superior  to  him, 
was  he  defeated.    Our  whole  civilization  is  unnatural  in 
the  sense  that  it  has  been  wrung  from  parsimonious 
nature  by  the  persistent  application  of  human  intelligence. 
To  believe  that  with  increasing  knowledge  we  should  be 
less  capable  of  solving  our  problems,  would  mean  to 
despair  of  ourselves  and  condemn  our  whole  development. 
The  scientist  may  say  with  justice  that  he  is  not  con- 
cerned with  the  whither  of  his  findings,  that  the  facts 
alone  matter,  irrespective  of  whether  they  are  encourag- 
ing or  discouraging.     That  is  true !     But  he  must  then 
take  a  sufficiently  large  number  of  facts  into  considera- 
tion.    Psychic  experiences  are  facts  as  much  as  rain 
and  sunshine.    The  will  to  conquer  is  as  important  as  the 
natural  fertility  of  a  valley.     Just  because  civilization 
has  been  largely  determined  in  the  past  by  natural  condi- 
tions, is  no  reason  why  it  should  always  be  so.     If  the 
tropics  have  been  uninhabitable  in  previous  ages  owing 
to  certain  diseases  or  climatic  conditions,  we  need  not 
despair  of  making  them  serviceable  to  the  teeming  mil- 
lions of  the  future. 

This  brings  us  back  to  our  original  question.  Where 
are  the  billions  of  the  future  to  get  their  food?  We  have 
pushed  north  nearly  as  far  as  we  can  go.  Ice-clad 
Siberia  and  snow-bound  Alaska  are  giving  us  their 
products  in  food  and  minerals.  But  we  shall  soon  have 
to  turn  south  to  the  tropics,  where  nature  rewards  even 
the  most  inefficient  labor  with  rich  harvests.  And  the 
problem  will  arise,  how  are  we  going  to  conquer  that 
vast  territory  from  whence  a  large  amount  of  our  food 
must  come  ?  In  the  past  man  had  no  solution,  because  he 
was  both  ignorant  and  cowardly.  And  his  ignorance  has 
exerted  a  vast  influence  upon  the  history  of  civilization. 


I 


iv  PREFACE 

It  was  chiefly  in  the  line  of  protecting  himself  against 
certain  diseases  that  he  was  deficient.  We  have  just 
begun  to  master  these,  and  with  this  mastery  the  con- 
quest of  the  tropics  is  certain.  Health,  in  other  words, 
has  been  the  most  important  factor  in  the  development 
and  extension  of  civilization. 

In  looking  beneath  the  surface  of  historic  events  we 
find  that  only  those  nations  which  enjoyed  at  least  fair 
health,  have  been  able  to  make  some  permanent  contri- 
bution to  the  welfare  and  enlightenment  of  their  con- 
temporaries and  of  future  generations,  because  they  alone 
had  sufficient  energy  to  procure  more  than  the  immediate 
necessaries  for  themselves.  Other  nations  merely  ex- 
isted; and  in  many  cases  we  know  of  them  only  through 
their  contact  with  the  healthy  and  vigorous  peoples  who 
usually  had  no  difficulty  in  enslaving  them. 

It  would  be  impossible  to  treat  the  effects  of  every 
disease  known  to  modem  medicine  upon  the  nations  of 
the  past.  An  interesting  book  might  be  written  about  the 
influence  of  tuberculosis  on  civilization,  especially  since 
people  began  to  gather  in  cities.  The  so-called  "social 
diseases"  have  undoubtedly  played  a  large  role  in  the 
fall  of  Egypt,  Greece,  and  Rome.  But  these  diseases, 
widespread  as  they  were,  affected  after  all  only  indi- 
viduals, and  not  whole  populations.  They  could,  more- 
over, be  guarded  against  by  living  in  the  open  air  and  by 

living  a  moral  life. 

Two  diseases— malaria  and  hookworm—have  accord- 
ingly been  selected  for  showing  the  influence  of  poor 
health  upon  many  races.  They  have  always  existed  in 
historic  times  at  least,  and  have  been  a  drawback  to  by  far 
the  majority  of  the  people  living  in  the  tropics,  sub- 
tropics  and  the  lower  latitudes  of  the  temperate  zones. 
Estimates  place  the  number  of  people  living  today  in  the 


PREFACE  w 

malaria  and  hookworm  zones  at  approximately  one  bil- 
lion. These  diseases  have  been  endemic  in  this  large  area 
from  times  immemorial,  and  are  responsible  for  the  low 
vitality  prevailing  in  those  regions.  Being  endemic,  there 
was  but  little  chance  for  anyone  in  that  territory  to  escape 
their  ravages.  Three  factors  favored  the  practically  un- 
checked course  of  these  diseases. 

In  the  first  place,  but  few  people  died  directly  as  a 
result  of  contracting  one  or  both  of  them ;  thus  little  was 
done  by  men  to  protect  themselves  against  an  attack,  as 
they  did,  however  inadequately,  against  epidemics.  In  the 
second  place,  there  was  the  general  religious  and  philo- 
sophical tendency  of  the  people  to  look  upon  diseases 
of  any  kind  as  a  visitation  from  some  deity  whose  wrath 
had  been  provoked  by  their  disobedience.  In  the  third 
place,  these  people  had  in  the  vast  majority  of  cases  no 
idea  of  the  true  nature  of  disease  and,  consequently,  no 
conception  of  how  to  cure  and  prevent  it.  The  specific 
for  malaria— quinine — has  been  known  to  Europeans  only 
since  the  seventeenth  century,  and  the  knowledge  of  its 
curative  properties  is  even  now  confined  to  civilized 
peoples.  There  was,  therefore,  no  escape  for  individuals 
and  races  living  in  the  infested  territories. 

With  the  beginning  of  the  twentieth  century  an  entirely 
new  page  opened  in  the  history  of  mankind,  for  we  not 
only  know  now  the  nature  of  these  and  other  diseases,  but 
also  the  remedies  to  cure  and  the  means  to  prevent  them. 
We  have  learned,  moreover,  that  health  and  long  life, 
which  were  looked  upon  as  gifts  of  the  gods,  are  matters 
having  a  relation  to  cause  and  effect,  and  are  dependent 
on  the  proper  observance  of  hygienic  rules  and  on  the 
establishment  of  sanitary  precautions.  There  is  no 
lonn^er  any  excuse  now  why  there  are  probably  at  all 
tm^  3,000,000  people  ill  in  the  United  States,  making 


▼1 


PREFACE 


an  average  of  thirteen  days  of  illness  per  annum  for  each 
inhabitant,  or  why  600,000  persons  should  die  prema- 
turely from  preventable  diseases.  This  means  not  only  a 
tremendous  economic  loss,  but  much  needless  suffering 
for  both  the  patients  and  their  families. 

Of  other  bearings  on  good  health,  mention  need  only 
be  made  of  the  fact  that  any  other  gift  or  talent  we  may 
have,  loses  much  of  its  power  to  make  us  happy  if  our 
health  is  below  normal.  A  man  may  have  the  wisdom  of 
Solomon,  but  with  poor  health  his  usefulness  is  reduced 
one-half.  A  few  men  of  exceptional  ability  have  done 
valuable  work  notwithstanding  poor  health;  they  were, 
however,  surrounded  and  assisted  by  others  who  took 
every  burden  off  their  shoulders.  This  was  the  case 
with  Herbert  Spencer  and  Charles  Darwin.  Of  what 
value  good  health  would  have  been  to  these  men,  they 
themselves  have  repeatedly  and  emphatically  expressed. 

The  view  that  there  is  generally  a  close  connection  be- 
tween poor  health  and  low  morals  is  becoming  more 
permanently  established  on  the  basis  of  scientific  investi- 
gations. A  better  and  more  intelligent  pursuit  of  health 
would,  consequently,  assist  in  solving  some  of  our  moral 
problems. 

Another  case  may  be  mentioned.  During  the  winter  of 
1913-14  New  York  and  other  large  cities  had  many  un- 
employed men  and  women.  A  careful  examination  of 
2,000  of  these  men  in  the  Municipal  Lodging  House  of 
New  York  brought  out  the  fact  that  about  seventy-five 
per  cent  of  them  were  below  the  normal  in  health,  not 
as  a  result  of  exposure  or  chronic  starvation,  but  of  poor 
constitution.  During  the  winter  of  1914-15  an  estimated 
number  of  unemployed  of  400,000  resulted  in  the  creation 
of  a  committee  on  unemployment,  headed  by  the  Mayor 
end  some  of  the  most  influential  business  men.    Very 


PREFACE 


vu 


little  has  been  heard  of  its  efficiency  in  procuring  jobs  for 
these  people.  But  if  the  total  percentage  of  low-vitality 
men  among  these  "  out-of-works  "  should  be  only  fifty 
per  cent — reckoning  those  in  the  municipal  lodging  house 
to  have  constituted  the  lower  strata  of  the  unemployed — 
it  would  seem  rather  useless  to  provide  jobs  for  people 
who  cannot  hold  them.  Many  men  are  unemployable  not 
because  they  are  unwilling  to  work  but  simply  because 
their  vitality  is  too  low  to  stand  the  strain  of  regular 
application  to  work.  It  would  seem  that  an  investigation 
into  the  physical  fitness  of  these  people  would  be  getting 
nearer  the  root  of  the  trouble  than  more  or  less  futile 
attempts  to  procure  work  for  them  which  after  a  few 
brave  but  vain  efforts  they  cannot  perform.  There  is 
always  a  large  amount  of  unemployment  during  the 
winter,  owing  to  season  work  and  other  causes.  But  the 
healthy  worker  will  save  a  little  during  employment,  his 
lodge  and  his  friends  will  help  him  out,  and  under  normal 
conditions  he  is  able  to  tide  over  the  winter.  Only  when 
abnormal  industrial  conditions  swell  the  number  of  the 
unemployables  by  large  numbers  of  healthy  employables, 
does  the  situation  become  acute.  If  the  low-vitality  men 
and  women  should  number  only  200,000  in  New  York 
City,  the  inference  seems  justified  that  they  are  supported 
by  their  families  all  the  time,  and  are  thus  responsible 
for  the  depressed  financial  condition  of  these  families. 
This  inference  is  borne  out  by  a  study  of  the  One 
Hundred  Neediest  Cases  of  New  York,  published  by  the 
Times  for  several  years.  An  analysis  of  these  cases 
shows  that  fully  fifty  per  cent  of  them  are  due  either 
directly  to  disease  or  to  low  vitality.  Better  attention  to 
health  and  sanitation  would  tend  to  solve  this  problem  to 
a  considerable  extent. 
Our  educational  systems  are  failing  to  meet  the  ex- 


rm 


PREFACE 


PREFACE 


IX 


pectations  of  the  more  advanced  members  of  the  com- 
munity, especially  those  of  physicians,  because  they  at- 
tempt to  convey  much  useless  information  to  children 
whose  prime  need  is  better  health.  The  British  govern- 
ment spends  about  i  15,000,000  a  year  on  education.  In 
many  of  the  colonial  schools  colored  children,  suffering 
from  malarial  enlargement  of  the  spleen,  are  taught  the 
dates  of  the  succession  of  the  Plantagenet  Kings,  while 
little  or  nothing  is  done  for  their  health.  Other  countries 
are  doing  more  in  this  direction,  notably  Sweden, 
Germany,  and  the  large  cities  of  America.  The  culture 
of  health  has,  however,  nowhere  been  given  the  central 
position  which  it  should  occupy  in  a  rational  educational 
S3rstem.  Yet  that  is  necessary  for  a  wholesome  national 
development 

That  this  statement  is  true  may  be  inferred  from  the 
facts  presented  herewith. 

Dr.  S.  Josephine  Baker  published  the  following  statis- 
tics in  The  Ladies'  Home  Journal,  for  May,  1918  (page 
89). 


"  There  are  in  the  schools  of  the  United  States  today  approxi- 
mately 20,000,000  pupils.    It  is  estimated  that : 

''300,000  to  400,000  of  these  have  organic  heart  disease. 

**  1,000,000  at  least  have  now,  or  have  had,  tuberculous  disease 
of  the  lungs. 

"  1,000,000  have  spnial  curvature,  or  are  flat  footed,  or  have 
some  other  deformity  serious  enough  to  interfere  to  some 
degree  with  health. 

**  1,000,000  have  defective  hearing. 

"5,000,000  have  defective  vision. 

"5,000,000  are  suffering  from  malnutrition,  in  many  cases  due 
in  part  at  least  to  one  or  more  of  the  other  defects  enumerated. 

**  6,000,000  have  enlarged  tonsils,  adenoids,  or  enlarged  cervical 
glands  which  need  attention. 

10,000,000  (in  some  scholi  at  high  as  98  per  cent)   have 


i< 


defective  teeth  which  are  potentially  if  not  actually  detrimental 
to  health. 

"Several  millions  of  the  children  possess,  each,  two  or  more 
of  the  handicapping  defects. 

"  15,000,000  of  the  school  children  in  this  country  are  in  need 
of  attention  today  for  physical  defects  which  are  partially  or 
completely  remediable." 

For  New  York  City,  >ve  have  the  following  data : — In 
1917,  247,735  children  were  examined  by  school 
physicians;  86,311  of  these  were  found  to  suffer  from 
various  defects;  104,587  were  found  to  suffer  from  de- 
fective teeth  exclusively.  This  makes  a  total  of  190,898, 
—certainly  a  very  hi|^  percentage  of  the  children  ex- 
amined. 

The  cost  of  health  supervision  of  the  children  In  the 
schools  of  New  York  was  42  cents  per  child  in  1915. 
This  is  a  very  small  amount  of  the  total  per  capita  cost 
of  educating  a  child,  which  is  $40  per  year. 

These  few  figures  show  that  we  are  not  spending  nearly 
as  much  on  health  in  our  schools  as  we  should. 

Much  of  the  perverse  thinking  and  acting  both  among 
children  and  among  adults  is  undoubtedly  due  to  low 
vitality,  or  actuaLphysical  defects.  A  brain  that  is  poorly 
nourished  readily  becomes  the  host  of  all  kinds  of  wild 
ideas  and  the  country  has  to  pay  for  it  in  various  forms 
of  expenditure  for  these  misfits  in  society. 

The  importance  of  one  of  the  diseases  considered  in 
this  book  has  been  brought  home  to  our  generation  by 
two  facts  of  the  present  world  war — the  Allied  Army  in 
Macedonia,  and  the  building  of  the  cantonments  of  the 
American  National  Army. 

Considerable  surprise,  if  not  annoyance,  has  been  ex- 
pressed at  the  comparative  inactivity  of  the  army  in 
Macedonst,  coniiiting  of  aoDroximatiav  750,000  men. 


X  PREFACE 

Measured  by  what  has  happened  on  other  fronts  of  the 
world  war,  this  army  has  done  practically  nothing.    Sur- 
mises of  every  possible  nature  have  been  advanced  as  an 
explanation  for  this  lack  of  activity.    Those  who  were  in 
that  field  knew  the  reason,  but  it  seemed  hardly  credible 
to  people  not  familiar  with  the  ravages  of  malaria.    Lest 
the  author  be  accused  of  exaggerating,  a  quotation  from 
a  man  who  has  studied  these  conditions  will  be  given  in 
order  to  show  that  the  most  dangerous  enemy  of  that 
army  was  neither  the  Turk  nor  the  Bulgar,  but  the 
malaria-bearing  mosquito.    Herbert  Corey  gives  the  fol- 
lowing description  of  the  effects  of  this  endemic  disease 
in  the  National  Geographic  Magazine  for  May,  1917. 

" the  malaria-bearing  mosquito  is  a  really  dangerous  en- 
emy. Last  year  the  Allied  troops  did  not  realize  what  the 
Macedonian  mosquito  can  do,  apparently.  They  were  not  pre- 
pared. In  consequence  fully  one-half  of  their  strength  was 
out  of  action  because  of  malaria. 

"During  one  period  more  men  were  invalided  home  than 
arrived  on  ships.  I  heard  of  battalions  with  75  per  cent  of 
their  men  on  their  backs,  and  of  companies  in  which  only  five 
men  were  fit  for  duty." 

It  will  take  time  and  skill  to  remove  this  enemy,  because 
Macedonia  is  malaria-ridden,  just  as  Greece  is  today  and 
has  always  been  since  the  time  of  Pericles. 

For  the  cantonments  of  our  National  Army  the  best 
sites  available  from  the  point  of  view  of  health  and 
sanitation  were  selected  in  1917.  It  was,  nevertheless, 
necessary  in  all  cases  to  spend  large  sums  of  money  in 
perfecting  such  arrangements,  and  in  all  the  cantonments 
located  in  the  Southern  States  to  pay  special  attention  to 
malaria.  Around  Camp  Pike,  near  Little  Rock,  Arkan- 
sas, an  area  of  about  seventy  miles  had  to  be  rendered 
mosquito  free,  although  it  is  located  approximately  200 


PREFACE 


XI 


feet  above  the  river  plane.  This  great  care  shows  that 
otir  experience  in  the  Panama  Zone  has  not  been  for- 
gotten, and  that  our  army  surgeons  are  fully  aware  of  the 
danger  lurking  in  malaria  against  the  efficiency  of  an 

army. 

Whatever  aspect  of  society  we  may  consider,  whether 
it  be  the  arts  of  peaceful  civilization,  or  the  clashing 
arms  of  war,  or  the  depressing  problems  of  social  in- 
efficiency or  the  future  of  the  nation,  we  are  always  led 
back  to  health  as  a  fundamental  factor  in  social  progress. 

Rudolph  M.  Binder. 

New  York  University, 
November,  1919. 


I  i  I 


PART  I 

GENERAL  RELATION  OF  HEALTH  TO 

SOCIETY 


^'»  . 


w 


CHAPTER  I 


INTRODUCTION 

Health  has  been  the  greatest  factor  in  the  history  of 
man,  since  it  is  the  strong  and  healthy  nations  which 
have  in  the  end  conquered  their  richer  and,  perhaps, 
more  civilized  neighbors.  For  man  had  to  contend  not 
only  with  man  in  the  struggle  for  existence,  but  with 
beasts  and  parasites.  The  battle  against  the  beasts  was 
decided  long  before  the  historic  period,  but  that  with 
man  and  parasites  still  continues.  In  his  fight  against 
disease  germs  man  has  frequently  succtunbed.  Whole 
tribes  and  even  nations  have  been  wiped  out  by  the  plague, 
cholera,  and  even  less  virulent  diseases.  And  even  to  this 
day,  in  his  battle  with  man,  the  parasites  play  an  im- 
portant role,  since  the  nation  which  knows  how  to  control, 
or  at  least,  change  the  activity  of  dangerous  micro- 
organisms has  an  advantage  of  great  importance*  over  its 
enemy.  In  times  past,  when  no  such  knowledge  existed, 
the  nation  which  lived  in  regions  comparatively  free  from 
parasites,  was  always  able  in  the  course  of  time  to  defeat 
its  more  numerous,  richer,  and  more  civilized  enemy. 
History  is  hardly  more  than  an  endless  repetition  of 
victories  by  peoples  coming  from  the  north  or  the 
mountains — localities  less  infested  with  disease  germs 
—over  peoples  living  in  rich  and  fertile  plains,  where 
these  germs  found  more  favorable  conditions  for  breed- 
ing. 

From  another  point  of  view  health  has  been  of  the 
Utmost  importance,— that  of  civilization.    Why  have  the 


4  HEALTH  AND  SOCIAL  PROGRESS 

tropical  and  sub-tropical  countries  never  attained  to  a 
permanent  civilization?     In  almost  every  part  of  the 
world  have  civilizations  sprung  up  around  the  latitudes 
of  the  Guicer  and  of  the  Capricorn,  only  to  flourish  for 
a  short  time,  and  perish  when  conditions  were  apparently 
propitious  for  a  higher  development.    Reasons  of  vari- 
ous kinds  have  been  assigned  for  this  short  life, — im- 
morality, luxury,  infidelity,  degeneracy,  political  oppres- 
sion, and  almost  everything  else  which  the  fertile  imagina- 
tion of  past  and  present  day  writers  could  conjure  up. 
All  these   reasons  undoubtedly  had  something  to  do 
with  the  ruin  of  ancient  civilizations,  but  they  operated 
only  indirectly,  and  were  themselves  results  rather  than 
causes.    It  is  only  recently  that  medicine,  with  its  study 
of  tropical  diseases,  has  revealed  the  true  cause, — ill- 
health  owing  to  the  inability  of  former  generations  to 
combat  disease-breeding  parasites.    For  without  physical 
health,  no  high  and  no  permanent  civilization  is  possible. 
If  ill-health  attends  a  people  day  after  day,  it  lacks  the 
ability  to  build  up  strong  and  vigorous  bodies  and  large, 
sound  brains.     It  is,  consequently,  compelled  to  reduce 
its  activities  to  the  absolutely  necessary  minimum,  since 
a  sick  man  does  not  act  or  think  any  more  than  he  is 
compelled  to  in  order  to  preserve  life.     No  civilization 
can  be  built  up,  however,  in  that  way.    It  requires  great 
physical   activity,   and,   above  everything  else,  a  clear 
and  vigorous  brain  to  invent  schemes  for  freeing  man 
from  the  thraldom  of  physical  toil.    For  only  in  propor- 
tion as  man  succeeds  in  making  nature  do  his  work,  is 
he  able  to  attain  leisure  and  to  save  time  and  energy  for 
the  development  of  art,  science,  philosophy,  and  litera- 
ture.   Civilization  has,  consequently,  a  mental  basis  even 
in  its  material  aspects  of  machinery  and  other  labor- 
saving  devices,  and  consists  essentially  in  the  ability  to 


INTRODUCTION  5 

enjoy  free  mental  activities  along  lines  which  give  men 
pleasure,  just  because  they  are  not  needed  for  physical 
maintenance.  These  activities  are,  however,  wholesome 
in  proportion  as  the  body  is  sound  and  vigorous,  since 
out  of  the  poorly  nourished  brain  of  a  chronic  dyspeptic 
or  the  disordered  brain  of  a  maniac  all  kinds  of  strange 
fancies  proceed,  which  are  neither  sound  nor  sane. 
Physical  health  is,  therefore,  an  essential  element  in  the 
origination  and  maintenance  of  civilization. 

This  fact  has  been  almost  entirely  overlooked  by  his- 
torians, theologians,  philosophers,  and  even  some  sociolo- 
gists. Human  beings  have  been  treated  as  if  they  were 
minds  without  bodies.  Writings  dealing  with  the  history 
of  man  in  its  various  aspects  contain  almost  no  references 
to  health  or  disease  except  occasionally  in  very  detailed 
biographies  or  when  a  war  or  an  epidemic  carried  off 
thousands  of  people.  This  silence  is,  of  course,  due  to 
the  supposed  independence  of  mental  states  from  bodily 
conditions,  survivals  of  which  we  have  in  the  various 
forms  of  mental  or  faith  healings  of  modem  times,  and 
in  our  attitude  toward  morality. 

Moralists  and  theologians  require  conformity  and 
obedience  to  rules  which  are  plainly  intended  only  for 
well  men.  Kant's  dicttun,  "  Thou  canst,  because  thou 
must ! "  is  evidently  teaching  of  this  kind,  because,  by 
implication  at  least,  the  person  who  recognizes  a  duty 
is  able  to  impose  his  will  upon  even  a  weak  and  diseased 
body,  and  make  it  do  the  work  of  one  that  is  well  and 
strong.  This  attitude  has  passed  over  into  our  legal 
codes,  and  we  often  punish  a  man  by  confinement  in  jail 
or  prison,  when  we  ought  to  send  him  to  the  hospital  or 
to  a  colony  for  the  feeble-minded. 

Health  seems  to  be  either  assumed  or  to  be  ignored 
in  the  treatment  of  man.     The  Puritan  considered  a 


I 


6  HEALTH  AND  SOCIAL  PROGRESS 

reference  to  his  physical  condition  as  sinful  or  at  least 
indelicate,  while  most  historians  were  either  silent  about 
the  body  or  treated  it  with  more  or  less  open  contempt 
Some  writers  openly  expressed  their  views  regarding  the 
body  as  an  obstacle  to  the  mind's  progress.  "  O  wretched 
man  that  I  am !  Who  shall  deliver  me  from  this  body  of 
death?"  says  St.  Paul  (Romans  7:24).  In  Schiller's 
"  Ideale  und  das  Leben  "  the  body  is  depicted  as  "  sink- 
ing, sinking,  sinking,"  as  the  mind— now  freed  from  its 
heavy  encumbrance— rises  higher  and  higher.  This  neg- 
lect and  contempt  of  the  body  goes  back  to  ancient 
times,  and  it  will  be  necessary  to  treat  the  attitude  of 
past  generations  in  regard  to  this  problem  at  least 
briefly. 

It  is  certainly  strange  that  such  an  important  fact  as 
physical  health  should  not  only  have  been  neglected,  but 
in  many  cases  distinctly  discouraged.  Religion  and 
philosophy  have  been  the  greatest  sinners  in  this  respect 
through  their  mistaken  notion  that  the  body  was  the  seat 
of  sin  and  hence  an  obstacle  to  the  development  of  the 
spirit,  while  science  has  always  taken  a  lively  and  sympa- 
thetic interest  in  fine,  healthy  physiques. 

Savages  have,  as  a  rule,  paid  more  attention  to  the  body 
than  civilized  peoples,  because  the  exigencies  of  their 
condition  always  called  for  whatever  physical  strength, 
skill,  prowess,  and  endurance  they  could  muster;  hence 
the  great  pains  taken  with  the  physical  education  of  boys, 
and  the  care  taken  by  the  warrior  of  his  health  that  he 
might  either  attain  the  chieftancy  or  retain  it.  Since 
efficiency  was  measured  in  warlike  qualities,  it  was  neces- 
sary that  the  body  should  be  made  chiefly  an  instrument 
for  fighting;  this  involved,  however,  incidentally  an  all- 
round  development  and  a  certain  amount  of  hygiene. 
The  comparatively  few  children  who  survived  the  hard 


INTRODUCTION  7 

conditions  of  life  were  the  most  vigorous,  and  perpetuated 
their  strength  through  their  own  offspring. 

The  Hebrews  are  conspicuous  from  this  point  of  view 
chiefly  for  their  laws  concerning  physical  cleanliness  and 
purification — the  effects  of  which  are  noticeable  to  this 
day,  since  a  race  has  been  created  with  strong  physical 
tenacity  and  a  high  vitality,  notwithstanding  the  confining 
life  of  the  Ghetto. 

Among  the  Greeks,  the  Spartans  stand  out  prominently 
in  this  respect,  since  they  trained  both  men  and  women 
with  the  greatest  care ;  the  former  to  be  efficient  warriors, 
the  latter  efficient  mothers. 

The  Athenians  undertook  physical  training  primarily 
for  the  sake  of  enjoyment ;  it  was  a  disgrace  for  a  gentle- 
man to  be  sick,  since  he  must  be  at  least  secondarily  a 
good  soldier.  It  may  be  said  that  health-culture  was 
raised  to  the  level  of  a  fine  art  among  the  Greeks,  which 
partook — as  did  all  arts  with  them — of  the  nature  of 
religion.  They  emphasized  the  element  of  health  for  the 
sake  of  proper  enjoyment  in  conformity  with  the  ideal 
of  their  gods,  as  the  Hebrews  insisted  on  cleanliness  and 
purity  in  obedience  to  the  ideal  of  Jehovah. 

Later  Greek  development  was  a  decidedly  retrograde 
movement.  Platonism  introduced  the  idea  of  the  op- 
position of  mind  and  matter — ^mind  being  conceived  as 
the  formative  principle,  matter  as  the  chaotic  and  un- 
formed. This  doctrine  placed  matter  in  a  position  of 
inferiority,  since  it  hindered  the  development  of  mind. 
When  this  idea  was  added  to  the  Hebrew  conception  of 
sin,  and  both  were  intensified  by  Christianity— the  result 
showed  itself  in  a  deprecation  of  the  body  in  every 
respect,  especially  since  it  came  to  be  looked  upon  defi- 
nitely as  the  seat  of  sin  and  the  obstacle  to  the  free 
development  of  the  spirit.    It  took  but  a  short  time  to 


1 


8  HEALTH  AND  SOCIAL  PROGRESS 

develop  the  "  unwashed  saints,"  Simon  Stylites,  and  other 
exponents  of  perverted  views  of  life. 

**•  •  •  •   •  .  I  die  here 
Today,  and  whole  years  long,  a  life  of  death. 
Bear  witness,  if  I  could  have  found  a  way— 
And  heedfully  I  sifted  all  my  thought- 
More  slowly-painful  to  subdue  this  home 
Of  sin,  my  flesh,  which  I  despise  and  hate, 
I  had  not  stinted  practice,  O  my  God  I" 

Modem  Christianity  has  not  taken  a  definite  attitude  in 
this  respect.     Its  advance  agents  exhibit  a  progressive 
tendency,  chiefly  for  the  sake  of  interesting  young  men 
and  women.     It  may  be  said,  however,  that  religion— 
whether  Jewish,  Christian  or  otherwise— can  never  ren- 
der the  service  it  should  render,  unless  it  adopts  the 
scientific  view  of  matter  as  spiritual,  and  returns  to  the 
primitive  Christian  ideal  of  the  body  as  "  the  temple  of 
the  Holy  Ghost."    This  view  is,  moreover,  decidedly  in 
favor  of  viewing  God  as  immanent  rather  than  trans- 
cendent—a movement  which  is  gaining  a  firm  foothold  in 
the  churches  owing  to  the  influence  of  science.    The  neg- 
lect of  the  body  and  the  conception  of  a  transcendent 
kingdom  of  God  have  retarded  a  true  civilizational  move- 
ment considerably,  since  physical  health,  which  is  the 
only  basis  for  mental  wholesomeness,  was  deprecated, 
and  the  "  other-worldliness  "  of  the  Kingdom  kept  men 
from  exerting  themselves  to  improve  conditions  in  this 
world. 

Science,  especially  medicine  as  the  science  of  health, 
has  always  favored  a  proper  view  of  the  body.  Owing  to 
the  imperfect  development  of  its  auxiliapAtiences,  e.g., 
chemistry,  physiology,  and  bacteriolog^ffedicine  was  un- 
til recent  times  more  or  less  hapraSard  guesswork  at 
curing  diseases,  but  has  now  developed  to  a  remarkable 


INTRODUCTION  9 

extent,  and  is  gaining  new  knowledge  almost  daily  con- 
cerning the  nature  of  diseases.  With  this  knowledge 
has  come  the  conception  of  prevention  as  the  true  sphere 
of  medicine,  rather  than  mere  cure.  The  prophylactic 
work  of  hygiene  in  its  diflFerent  aspects  has  produced 
remarkable  results.  Medicine  has,  moreover,  joined 
hands  with  the  engineer  and  the  physical  culturist  in 
various  successful  attempts  at  sewage  disposal,  sanitation, 
ventilation,  and  a  more  systematic  development  of  the 
body. 

Biology  and  psychology  deal  chiefly  with  life  as  it  is 
actually  found,  but  work  indirectly  for  betterment  of 
health,  because  only  normal  and  healthy  individuals  in- 
sure, as  a  rule,  progress. 

Sociology  is  concerned  with  the  causes  of  the  progress 
and  decline  of  nations.  It  is  par  excellence  the  advocate 
of  health—physical,  psychical,  political,  social,  and  in- 
dustrial— since  the  efficiency  of  nations  and  races  de- 
pends on  the  maintenance  of  health. 

Eugenics,  finally,  is  a  new  branch  of  biology  and  soci- 
ology, and  attempts  to  solve  the  problem  of  racial  health 
by  proper  mating  of  the  physically  and  mentally  fit,  and 
by  the  elimination,  of  the  unfit  through  prohibition  of 
mating. 

These  various  eflForts  have  produced  many  important 
results  in  lessening  the  amount  of  sickness,  improving 
health,  and  chiefly  in  changing  our  whole  attitude  toward 
the  body  as  the  instrument  of  the  mind. 

In  no  period  of  history  was  health  considered  of  such 
great  importance  as  it  is  in  our  own  times.  In  practically 
every  sphere  of  life,  people  take  the  greatest  interest  in 
their  physical  and  mental  well-being.  Individuals, 
schools,  voluntary  associations  of  various  kinds,  even 

fovcmmcnti  btve  takta  up  thii  quMtion  with  %  Kit 


10 


HEALTH  AND  SOCIAL  PROGRESS 


INTRODUCTION 


11 


!! 


that  augurs  well  for  the  future.  The  number  of  books 
which  have  been  written  on  this  topic,  is  literally  more 
than  the  proverbial  legion.  From  the  platform,  in  lec- 
tures and  pamphlets,  in  newspaper  and  magazine  articles, 
we  are  told  how  to  keep  well.  The  ntunerous  health- 
resorts,  sanatoria,  and  similar  institutions  which  promise 
to  build  up  broken-down  constitutions  are  filled  to  their 
utmost  capacity  and  new  ones  are  established  every  year. 

What  is  the  reason  for  this  great  interest  in  health? 
Are  we  more  ill  than  our  ancestors,  or  are  there  special 
causes  in  our  times,  which  demand  greater  consideration 
of  health? 

Whether  we  are  in  better  health  than  our  ancestors  is 
a  much  debated  question  among  sociologists  and  need  not 
be  entered  into  here.  Data  will  be  given  in  a  later  chapter 
(see  page  28)  to  answer  the  question  in  the  affirmative. 
The  reasons,  however,  for  our  great  interest  in  health  arc 
plain,  and  they  may  be  divided  into  social  and  scientific 

Whatever  the  ultimate  relation  of  mind  and  body  may 
be,  no  person  denies  the  tremendous  importance  of  a 
sound  body  as  an  instrument  of  the  mind,  especially  in 
relation  to  social  life  in  its  various  aspects.  Our  indus- 
trial life  has  created  conditions  which  make  a  close  inter- 
dependence of  one  man  upon  another  an  absolute  neces- 
sity. Formerly  when  a  man  was  ill,  his  work  could  wait 
until  he  was  well,  and  no  one  else  was  inconvenienced ;  but 
.  if  an  employee  in  a  factory  is  unable  to  perform  his  duty, 
hundreds  if  not  thousands  of  other  employees  have  to 
stop  work  owing  to  the  dependence  of  one  operation  upon 
every  other.  The  financial  loss  is,  of  course,  too  great  to 
do  that,  and  the  sick  employee  must  be  replaced  by  an- 
other. Again,  if  a  farmer  while  driving  to  town  gets 
dizzy  and  falls  from  the  wagon,  his  horses  may  run 
away  and  he  may  break  his  neck,  but  the  dsimage  is  con* 


fined  to  himself  and  family.  If  a  locomotive  engineer 
suffers  from  a  similar  affliction  and  runs  his  train  at  full 
speed  into  an  open  switch,  hundreds  of  people  may  be 
killed  or  maimed  for  life.  These  are  but  two  out  of 
many  cases  in  which  modem  conditions  differ  funda- 
mentally from  those  of  former  days  or  from  those  in  our 
own  times  where  a  man  still  works  singly.  Hence  the 
importance  of  health  in  modem  industry. 

Briefly  stated,  health  in  relation  to  modem  conditions 
may  be  viewed  from  five  aspects:  (1)  The  proper  per- 
formance of  one's  work  and  duty  is  impossible  without 
at  least  fair  health.  A  man  may  force  himself,  but  in  that 
case  his  work  will  be  done  poorly,  or  the  wear  and  tear 
on  the  constitution  will  be  so  enormous  as  to  bring  about 
a  considerable  weakening,  thus  predisposing  the  worker 
to  disease,  or  at  least  lowering  the  power  of  resistance. 
(2)  Apart  from  the  mere  performance  of  work  is  that 
of  exactness  and  accuracy.  A  man  enjoying  good  health 
is  less  apt  to  make  mistakes  than  one  who  is  below 
normal.  That  means  an  immense  saving  in  time,. money, 
friction,  mental  wear  and  tear  to  himself  and  to  the 
establishment,  since  such  work  needs  less  supervision  and 
scarcely  ever  a  doing-over.  (3)  Ease  and  cheerfulness  at 
work  is  another  important  aspect.  There  is  a  tremendous 
difference  between  a  worker  whose  body  is  ready  to  per- 
form, craving  an  outlet  for  its  abundance  of  energy,  and 
one  whose  body  protests  almost  at  every  step  taken,  and 
still  more  against  the  continuous  exertion  during  work. 
The  former  will  work  with  ease,  sing  and  joke;  the  latter 
will  watch  the  hand  of  the  clock  and  sigh  with  relief  when 
It  strikes  six.  (4)  When  the  two  leave  the  shop,  the  dif- 
ference between  them  still  continues  in  their  recreation. 
The  present  tendency  is  everywhere  for  shorter  hours  so 
as  to  give  the  worker  more  leisure.    But  what  can  a  man 


12        HEALTH  AND  SOCIAL  PROGRESS 

do  with  his  leisure  when  he  is  so  tired  out  that  he  is 
scarcely  able  to  drag  himself  up  the  steps  of  his  house. 
He  IS  unable  to  use  it  for  reading  or  social  intercourse ; 
the  chances  are  that  he  will  seek  a  stimulant  to  create  an 
artificial  cheerfulness.    The  other  man  has  at  least  the 
opportunity  to  improve  his  mind  by  reading,  going  to  a 
lecture,  or  through  social  intercourse.     (5)  The  purely 
social  value  of  good  health  is,  perhaps,  more  important 
than  any  other.    Exuberant  spirits  and  robust  health  are 
distinct  social  assets.    We  all  feel  instinctively  drawn 
toward  a  cheerful,  pleasant-spoken   person;  his  very 
presence  is  a  blessing,  his  smile  contagious,  and  he  is 
welcome  wherever  he  goes.    The  father  returning  from 
work  with  a  cheerful  smile  and  a  pleasant  word  for 
wife  and  children,  is  anxiously  looked  for,  because  he 
spreads  sunshine  in  the  house.    The  man  who  is  wearied 
through  work,  owing  to  low  vitality,  is  inclined  to  find 
fault  with  everyone  and  everything,  and  is  shunned,  be- 
cause he  spreads  gloom  by  his  very  presence.    From  a 
dramatic  and  literary  point  of  view  "  Rebecca  of  Sunny- 
brook  Farm  "  may  be  inferior,  but  from  the  social  point 
it  is  a  distinct  asset,  because  it  proves  the  value  of  good 
health  and  a  cheerful  disposition. 

The  scientific  reasons  for  fostering  health  are  some- 
what more  remote,  but  none  the  less  real.  The  rapid 
expansion  of  the  natural  sciences,  especially  of  biology, 
during  the  nineteenth  century,  contributed  many  elements 
toward  a  change  in  our  attitude  toward  the  body,  since 
the  doctrine  of  evolution  depends  primarily  on  the  good 
health  of  the  various  species.  The  survival  of  the 
fittest  meant  in  the  animal  realm  and  for  a  long  time  in 
human  history,  the  survival  of  the  physically  fit,  because 
only  the  organism  endowed  with  strength,  fleetncss,  or 
oAer  phyiical  charactcriitia  iniuring  lupcriority  had  a 


INTRODUCTION  13 

chance  to  survive  and  propagate.  These  qualities  are, 
however,  reducible  to  health,  since  without  that  they 
could  not  be  developed;  nor  are  they,  if  developed,  of 
much  use  without  it,  since  the  swiftest  wing  or  foot,  the 
strongest  jaw  or  claw  would  be  incapacitated  by  disease. 
An  animal  might  react  promptly  and  efficiently  hundreds 
of  times  in  escaping  its  enemies,  but  the  parasites  in  its 
own  system  it  could  never  escape.  Hence  there  is  no 
natural  death  among  the  majority  of  animal  species,  be- 
cause when  the  bacteria  have  lowered  vitality,  even  the 
swiftest  and  the  strongest  fall  a  prey  to  their  enemies. 

The  interest  in  biology  led  in  its  turn  to  the  various 
attempts  to  explain  man's  nature  on  the  basis  of  his 
environment,  and  as  a  result  of  this  new  view  of  life. 
Buckle  wrote  his  History  of  the  Civilisation  of  England, 
and  Ratzel  his  Anthropo-Geographie.  "  Man  can  no  more 
be  scientifically  studied  apart  from  the  ground  which  he 
tills,  or  the  lands  over  which  he  travels,  or  the  seas  over 
which  he  trades,  than  the  polar  bear  or  the  desert  cactus 
can  be  understood  apart  from  its  habitat.  Man's  rela- 
tions to  his  environment  are  infinitely  more  numerous 
and  complex  than  those  of  the  most  highly  organized 
plant  or  animal.  So  complex  are  they,  that  they  con- 
stitute a  legitimate  and  necessary  object  of  special  study. 
Ihe  investigation  which  they  receive  in  anthropology, 
ethnology,  sociology,  and  history  is  piecemeal  and  partial, 
limited  as  to  race,  cultural  development,  epoch,  country 
or  variety  of  geographic  conditions  taken  into  account.' 
Hence  all  these  sciences,  together  with  history,  so  far  as 
ftistory  undertakes  to  explain  the  causes  of  events,  fail 
to  reach  a  satisfactory  solution  of  their  problems  largely 
^cause  the  geographic  factor  which  enters  into  them  all 
^  not  been  thoroughly  analyzed.  Man  has  been  so  noisy 
aoout  the  way  he  has  conquered  nature,  and  nature  has 


* 


14        HEALTH  AND  SOCIAL  PROGRESS 

been  so  sflent  in  her  persistent  influence  over  man,  that 
the  geographic  factor  in  the  human  equation  has  been 
overlooked."  * 

These  studies  led  to  an  investigation  of  the  disappear- 
ance of  nature-peoples,  and  it  was  found  that  their  decay 
and  extinction  was  due  not  so  much  to  the  cruelty  of  the 
"  white  man,"  as  to  various  endemic  diseases,  some  of 
which  had  existed  among  them  for  many  generations  and 
became  more  virulent  under  new  conditions  of  life,  while 
others  were  introduced  by  civilized  man  on  his  advent  in 
new  countries.  It  is  no  exaggeration  to  say  that  the  fate 
of  many  nations  and  innumerable  tribes  has  depended  on 
various  diseases;  and  chiefly  the  endemic,  because  epi- 
demics caused  as  a  rule  great  mortality,  and  thus  by 
attracting  attention,  produced  measures  to  combat  them, 
while  endemics  worked  insidiously  and  more  injuriously, 
leaving  the  people  in  ignorance  of  their  danger.  The 
Greeks  and  the  Romans,  for  instance,  were  never  aware 
of  the  danger  which  threatened  them  through  malaria, 
and  took  no  measures  to  counteract  its  ravages.  The 
study  of  the  disappearance  of  nature-peoples  through 
disease  created  a  new  interest  in  health  among  civilized 
peoples,  especially  among  physicians  who  had  worked  In 
tropical  countries. 


1 


J 


CHAPTER  II 


MEANING  OF  HEALTH 


What  is  health?  In  defining  or  even  describing  health 
much  depends  on  the  point  of  view.  The  average  man 
considers  himself  healthy  when  he  is  not  ill,  and  many  a 
person  who  is  suffering  from  an  endemic  disease,  e.g., 
malaria  or  hookworm,  considers  himself  well,  just  be- 
cause he  is  not  seriously  sick.  The  physiologist  would 
consider  health  as  a  normal  functioning  of  the  cell,  be- 
cause he  takes  that  as  the  unit  of  his  investigation.  The 
sociologist,  on  the  other  hand,  looks  upon  the  body  from 
the  point  of  view  of  action,  and  he  must  describe  health 
in  terms  of  the  whole  man  as  he  reacts  upon  the  various 
stimuli  which  come  either  from  within  or  from  without. 
These  reactions  are,  however,  ultimately  mediated  in  the 
brain  or  in  the  mind,  and  they  will  be  the  more  perfect 
and  economical,  the  less  friction  there  is  in  the  physical 
organism.  Hence  we  may  say  that  a  person  is  healthy 
when  he  is,  except  incidentally,  unconscious  of  his  body. 
The  definition  may  seem  strange  at  first  sight,  but  it  im- 
plies all  the  elements  which  enter  into  a  full  description 
of  health.  It  means  the  state  of  body  which  enables  it 
to  perform  every  function  which  can  reasonably  be  ex- 
pected of  it,  to  accommodate  itself  to  each  ordinary  task, 
and  to  be  equal  to  some  exertion  without  painful  sense  of 
fatigue.  This  implies  as  external  signs  erectness  and 
firmness ;  as  internal  requisites,  good  construction,  ability 
to  adapt  itself  to  widely  divergent  conditions  of  life  or  of 
climate  without  deterioration  of  energy;  endurance,  re- 

15 


16        HEALTH  AND  SOCIAL  PROGRESS 

sistance  to  morbific  influences ;  and  finally,  it  means  self- 
control — mental,  emotional,  and  sexual ;  briefly,  a  balance 
between  organs  and  organism,  so  as  to  produce  a  coordi- 
nated whole,  well  equipped  for  action. 

This  description  does  not  refer  to  robust  health,  but 
merely  to  a  person  who  is  well.    It  may  be  illustrated 
briefly  as  follows :  The  healthy  man  wakes  in  the  morn- 
ing without  any  recollection  of  what  happened  since  he 
went  to  bed,  since  he  has  had  a  continuous,  unbroken,  re- 
freshing sleep.    He  is  ready  to  get  up  and  has  no  desire 
to  linger  in  bed;  his  toilet  is  performed  without  delay, 
for  he  is  hungry,  and  has  visions  of  breakfast.    When  this 
is  over,  he  proceeds  to  the  business  of  the  day  at  once, 
whatever  that  may  be,  since  he  loves  his  work.    This  he 
does  with  all  diligence  and  dispatch,  because  his  body 
answers  to  the  summons  of  the  mind  with  ease  and 
accuracy.     Hence  he  will  not  be  exhausted  when  the 
day's  work  is  done,  but  will  have  some  energy  left  over 
for  exercise,  friendly  intercourse,  or  mental  improvement. 
Then  he  goes  to  bed,  and  is  soon  asleep.    This  man  has 
scarcely  been  conscious  of  his  body  either  by  night  or  by 
day  except  incidentally  when  washing,  dressing,  and  eat- 
ing.   If  he  had  any  sensations  at  all  about  it,  they  were 
pleasant,  at  least  mildly  so,  since  the  sense  of  organic 
well-being  is  one  of  diffused  pleasure.     He  enjoys  his 
meals,  but  never  has  to  care  what  becomes  of  the  food 
afterward,  since  his  digestive  organs  perform  their  work 
automatically ;  he  may  perhaps  remember  his  meals  again 
through  an  increase  of  strength  and  well-being. 

Perhaps  the  best  thing  about  good  health  is  the  fact 
that  work  does  not  weary  us,  but  helps  to  develop  our 
various  faculties.  Hence  the  day's  work  always  leaves 
us  in  better  condition  than  it  found  us;  it  has  opened 
new  possibilities  before  us,  has  given  us  opportunities 


MEANING  OF  HEALTH 


17 


for  exercising  our  various  powers  and  for  spending  our 
surplus  energy.  The  healthy  man  is  able  to  make  every 
movement  graceful,  effective,  and  adaptive;  and  the 
profit  from  the  day's  experience  will  enable  him  to  do 
tomorrow's  work  better.  He  re-creates  himself  con- 
stantly. 

It  is  not  necessary  to  point  out  that  good  health  is  not 
identical  with  athletic  strength  or  endurance.  The  tasks 
of  life  differ,  and  each  task  requires  a  slightly  different 
physique,  as  Aristotle  observed  in  his  Politics  (Book  I, 
Chapter  VI).  The  health  and  strength  of  a  hod-carrier 
must  be  different  from  that  of  a  professional  man ;  the 
former  needs  a  well-developed  muscular  system,  the  latter 
an  especially  fine  brain  and  nervous  system.  If  each  is 
able  to  perform  his  particular  work  well  and  without 
exhaustion,  he  fulfills  his  destiny,  and  renders  not 
only  a  social  service  but  gets  profit  and  pleasure  from 
it. 

Health  may  be  identified  with  good  vitality,  or  surplus 
energy.  Good  vitality  means  simply  a  reserve  fund  be- 
yond what  is  immediately  needed.  The  greater  this  re- 
serve, the  better  prepared  is  the  organism  to  meet  all 
kinds  of  exigencies  with  ease,  and  to  stand  shocks  with- 
out serious  injury. 

"Two  men  undergo  operations  of  the  same  character  in  a 
hospital.  The  same  surgeon  does  the  work.  The  conditions 
are  identical.  Equal  care  is  exercised  in  each  operation,  and 
each  is  successfully  performed.  Yet  one  man  recovers,  the  other 
dies. 

'There  is  a  tremendous  business  pressure  which  does  not 
let  up  for  months.  It  puts  men  under  terrible  strain.  One  man 
goes  to  pieces  and  his  business  is  wrecked.  He  cannot  keep 
the  pace;  he  loses  control  of  himself.  His  rival  has  no  better 
brains  than  he-i)erhaps  not  so  good— yet  he  pulls  through  suc- 
cessfully. 


m 


4ii 


18        HEALTH  AND  SOCIAL  PROGRESS 

"  We  say  that  there  is  a  difference  in  vitality ;  that  one  man 
has  more  of  it  than  the  other. 

"I  once  saw  a  man  in  a  hospital  who  was  suffering  from 
five  fatal  diseases ;  and  yet  he  would  not  die.    He  kept  on  living 

^^"«r  /  r*'  '"  'P^*^  °^  everything.  He  refused  to  succumb. 
We  find  the  same  thing  illustrated  every  day.  In  a  ship- 
wreck there  are  many  who  seem  to  give  up  their  lives  without 
a  struggle,  without  any  power  to  resist.  Others  cling  to  an 
open  raft  for  days  without  food,  almost  frozen,  constantly 
whipped  by  the  waves,  but  for  some  reason  they  survive.  The 
vitality  in  them  is  strong. 

"Notice  how  rapidly  and  surely  one  man  recovers  himself 
after  a  nervous  breakdown,  while  another  drags  along  through 
years  of  semi-invalidism.  Notice  the  results  upon  two  men  of 
a  long,  cold  drench  of  rain.  One  of  them  comes  down  with 
pneumonia;  the  other  suffers  no  iU  effects.  How  is  it  to  be 
explained  ? 

"  He  has  a  reserve  somewhere,  an  inner  power  of  resistance, 
an  aggressive  something  that  will  not  be  downed— and  we  call 
It  vitality.    A  man  cannot  have  a  more  valuable  asset  than  that 
It  means  joy  instead  of  dumps,  success  instead  of  failure,  life 
perhaps,  instead  of  death."  a  * 

No  one  will  contend  that  under  the  circumstances  just 
quoted,  a  healthy  man  is  unconscious  of  his  body;  but 
these  men  were  sick  for  the  time  being,  and  their  cases 
are  cited  merely  to  show  that  men  who  enjoy  good  health 
store  up  surplus  energy  or  vitality  which  stands  them  in 
good  stead  in  an  emergency.    At  such  times  there  is  still 
a  vast  difference  between  the  man  in  good  health  and  the 
one  in  poor  condition.     When  special  stress  is  to  be 
borne  calling  for  great  exertion,  the  man  in  poor  con- 
dition will  dread  the  necessity,  become  apprehensive,  and 
thus  spend  his  energy  ineffectively;  while  the  well  man 
will  look  forward  with  confidence  to  the  trial  of  strength 
and  react  efficiently.    He  is  able  to  do  this  because  when 
he  becomes  clearly  conscious  of  his  body,  he  is  aware 
of  his  strength  and  power;  his  whole  organism  seeks 


MEANING  OF  HEALTH 


19 


relief  from  the  tension  of  stored-up  energy;  while  the 
other,  always  more  or  less  conscious  of  its  existence, 
now  becomes  more  than  ever  aware  of  its  weakness  and 
slender  resources.  Under  normal  conditions  the  well 
man  is,  however,  as  a  rule  unconscious  of  his  body,  unless 
it  be  an  awareness  of  diffused  organic  well-being. 

This  fact  may  be  illustrated  in  other  ways.  A  healthy 
child  who  laughs  and  runs  and  romps,  acts  spontaneously, 
not  deliberately.  When  he  has  to  be  urged  and  coaxed 
to  do  these  things,  he  is  not  well ;  he  is  conscious  of  an 
effort,  he  must  exert  himself,  and  the  more  he  does  so, 
the  more  conscious  he  becomes  of  his  weakness.  A  young 
dog  who  for  no  reason  whatever  will  run  up  and  down 
the  avenue  as  fast  as  he  possibly  can  is  unconscious  of 
his  body.  Only  after  he  has  spent  his  surplus  energy 
and  needs  rest  and  food  is  he  aware  of  his  legs  and 
stomach. 

Health  means,  then,  spontaneity  and  freedom  of  action. 
"  It  is  as  *  the  outward  sign  of  freedom,  the  realization 
of  the  universal  will '  that  health  may  be  set  at  once  as 
sign  and  goal  of  the  harmonious  operation  of  the  whole 
system — ^as  sign  and  goal  of  the  realization  of  life."  • 

A  healthy  man  is  able  to  turn  his  energy  in  any  direc- 
tion desired,  because  his  body  responds  promptly  and 
efficiently ;  its  energy  is  always  ready  to  be  expended.  It 
is  usually  the  man  in  poor  health  who  has  to  "  make  up 
his  mind " ;  the  one  in  good  health  is  able  to  decide 
quickly,  because  with  a  clear  brain  and  efficient  nervous 
system  he  can  instantly  "  feel  the  situation,"  devise  a  plan 
immediately,  and  say  "  yes  "  or  "  no."  The  other  man 
must  in  reality  get  his  body  ready;  he  has  too  little 
energy  to  meet  the  new  situation  at  once,  and  asks  for 
delay  in  order  to  "  think  it  over  "  when  he  is  not  other- 
wise occupied.    To  conclude,  then,  health  m^ans  freedom 


20        HEALTH  AND  SOCIAL  PROGRESS 

of  action  because  it  implies  being  unconscious  of  the  body 
— owing  to  surplus  energy. 

This  principle  may  be  proved  by  a  reference  to  the 
meaning  of  disease.    In  health  all  life-functions  proceed 
without  any  friction  and  self-assertion  on  the  part  of  the 
organs,  hence  the  individual  is  normally  unaware  of  his 
body.    But  let  some  organ  get  out  of  order,  and  we  soon 
become  aware  of  its  existence.    The  very  fact  that  pain 
is  a  danger  signal  implies  that  generally  the  operations  of 
a  well-ordered  body  proceed  smoothly  and  unconsciously. 
Pain  means,  therefore,  that  a  particular  part  of  the 
organism  is  unable  to  carry  on  its  work  unconsciously; 
while  usually  so  contented  to  serve  the  organism  in  ob- 
scurity and  oblivion,  it  asserts  itself  vigorously  the  mo- 
ment it  can  no  longer  do  so,  and  notice  is  given  to  the 
whole  body  through  the  nervous   system  that   help   is 
needed.    For  pain  is  merely  the  cry  of  nerves  that  are 
either  starved,  poisoned,  or  throttled.    And  the  finer  the 
organism  is  constructed,  and  the  more  delicately  balanced 
the  various  parts  are,  the  better  is  the  signal  service  of 
danger  organized.    Hence  the  higher  species  of  animals 
and  the  more  finely  grained  human  beings  are  more  sus- 
ceptible to  the  slightest  disturbances.    The  ox-cart  of  a 
Montenegro  peasant  will  render  fair  service  after  many 
parts  are  out  of  repair  and  some  even  broken;  but  the 
automobile  of  fine  construction  will  "  go  out  of  commis- 
sion "  the  moment  one  small  screw  is  loose  or  lost.    So 
the  savage  will  bear  a  fracture  of  an  arm  or  even  a 
slight  one  of  the  skull  with  comparative  equanimity  after 
the   first   shock;   he   usually   recovers   quickly    without 
medical  attendance:  the  finely  grained  European  may 
suffer  intensely  and  take  considerable  time  for  recovery ; 
he  cannot  even  witness  pain  in  other  men  or  animals  with- 
out sympathy,  or  suflFering  with  the  other.    Homer  un- 


MEANING  OF  HEALTH 


21 


consciously  intimated  that  the  Greeks  were  more  highly 
civilized  than  the  Trojans  when  he  said  that  the  former 
felt  pain  more  keenly  as  witnessed  by  their  outcries,  while 
the  latter  were  mute  even  when  wounded  severely.  The 
same  principle  applies  to  Mars,  of  whom  we  are  told  that 
he  roared  with  pain  when  struck  by  the  spear  of  Dio- 
medes,  for  as  a  divine  being  his  nervous  system  would 
naturally  be  more  highly  organized.* 

In  the  anxiety  to  avoid  injury,  i,e.,  to  disturb  the 
balance  between  the  various  parts,  nature  has  devised 
innumerable  schemes  through  division  of  labor  in  order 
to  scent  danger  before  it  actually  reaches  us.  This  princi- 
ple is  most  ingeniously  elaborated  in  the  case  of  the 
curious  antennae,  or  feelers,  which  are  thrust  out  from 
the  surface  of  the  body  in  animals  of  all  sorts,  especially 
in  insects.  Its  most  striking  development  is  the  well- 
known  whiskers  of  the  cat,  and  the  less  familiar,  but 
much  more  highly  developed,  tactile  hairs  about  the  head 
of  the  bat.  These  feelers  extend  from  half  an  inch  to  an 
inch  from  the  body  in  order  to  warn  it  of  approaching 
danger  through  the  sense  of  touch.  In  more  highly 
organized  animals  the  senses  of  sight,  hearing,  and  smell 
are,  in  part  at  least,  intended  to  be  guards  against  danger, 
extending  their  sphere  over  much  larger  areas.  The 
reason  for  this  extraordinary  sensitiveness  to  pain  and 
these  precautions  against  danger  is  the  extreme  care 
which  the  organism  takes  in  preserving  its  integrity  or 
wholeness.  For  if  the  danger  signal  is  to  be  of  any 
value,  it  must  be  accurate  so  as  to  report  the  slightest  de- 
viation from  the  normal,  and  must  be  placed  as  far  in 


^uV^^J'^^^.^'  "Bellowed  brazen-throated  Mars,  loud  as  nine 
Tro^fn.     warriors,  or  as  ten  joined  in  close  combat.     Grecians, 
irojans,  shook,  appalled  alike  at  the  tremendous  voice  of  Mars 
msatiaWe  with  deeds  of  Wood/'  ' 


72        HEALTH  AND  SOCIAL  PROGRESS 

the  foreground  of  the  battle  as  possible  so  as  to  give  time 
for  measures  of  avoidance. 

Accuracy  in  interpreting  danger  signals  is,  however, 
possible  only  in  good  health,  whether  the  danger  is  from 
within  or  from  without.  An  organ  which  is  in  poor  con- 
dition asserts  itself  so  peremptorily  and  constantly,  that 
other  organs  may  be  neglected  or  are  made  to  suffer,  and 
thus  become  unable  to  do  their  work  properly.  The  nose 
is  a  useful  organ  and  performs  valuable  services  to  the 
organism  all  more  or  less  unconsciously  to  ourselves; 
for  while  it  is  in  a  sound  condition  we  act  promptly  on 
the  information  it  gives  us,  and  are  hardly  aware  of  its 
existence  for  weeks  at  a  time.  A  cold  in  the  head  very 
quickly  changes  this  relation.  Our  sense  of  smell  suflFers 
almost  instantly  and  we  are  less  able  to  judge  accurately 
of  the  information  received  from  that  quarter.  But  that 
is  not  all.  This  organ  asserts  itself  so  vigorously  at 
such  a  time  that  we  are  but  little  able  to  do  anything  else 
than  attend  to  it.  Neighboring  organs  are  likewise  af- 
fected, e.g.,  the  eye,  which  becomes  watery,  and  the  ear, 
which  becomes  less  acute  and  discriminating — we  hear 
noises  rather  than  distinct  sounds,  and  fewer  of  them. 
The  three  main  sentinels  against  external  danger  are 
thus  invalidated.  And  what  happens  to  the  organism? 
It  is  more  or  less  out  of  working  order,  less  aggressive, 
less  capable,  perhaps  incapacitated.  Why?  Because  the 
nose  asserts  itself  so  vigorously  that  most  of  the  energy 
produced  by  the  organism  is  drawn  into  service  for  re- 
pairing the  breach  made  in  its  wholeness.  For  the  sys- 
tem must  be  whole  if  it  is  to  function  properly  in  the 
various  exigencies  of  life.  If  a  more  important  organ 
is  hurt,  we  call  ourselves  sick  and  go  to  bed,  so  as  to 
give  the  organism  an  opportunity  to  attend  to  its  repair 
work  exclusively  for  at  least  some  time, 


MEANING  OF  HEALTH  23 

Health   means,   moreover,   economy   of   expenditure. 
While  there  is  much  friction  in  the  organism  during  sick- 
ness in  performing  even  the  most  elementary  work,  there 
is  hardly  any  during  health.    We  simply  go  ahead,  un- 
mindful of  our  body.    It  is  a  ready  instrument  of  the 
mind,  and  we  realize  its  existence  only  at  night  when 
tired  out.    That  feeling  of  lassitude  is  simply  a  signal  to 
stop  and  rest.     It  is  not  an  unpleasant,  but  rather  an 
agreeable  feeling  to  relax  and  go  to  sleep.    A  few  hours 
of  rest  are  sufficient  to  restore  our  energy,  and  we  wake 
up  automatically,  ready  to  go  to  work  again.    Compara- 
tively little  food  is  needed  to  keep  a  healthy  person  in 
good  condition,  because  no  repair  work  is  needed  and  the 
power  of  assimilating  all  nutrient  elements  is  strong.    A 
physician  said  a  few  years  ago  concerning  a  patient  who 
suflFered  from  consumption  of  the  throat,  that  her  food 
had  sufficient  nutrient  values  to  keep  seven  ditch-diggers 
in  good  health.     Still,  that  young  woman  cbuld  hardly 
move  in  bed  without  severe  pain.     We  are  surprised 
when  we  read  of  the  black  bread,  a  piece  of  cheese,  and 
the  small  amount  of  sour  wine,  which  keep  many  Euro- 
pean peasants  not  only  in  good  health,  but  literally  in  good 
working  condition.    There  is  no  secret  about  it,  though ; 
the  system  does  not  waste  anything,  and  new  energy  is 
quickly  supplied  by  simple  food  and  sleep.    The  China- 
man with  his  handful  of  half-cooked  rice  is  even  a 
better  example.     He  works  hard  and  continuously  on 
this  scanty  food,  and  seems  to  be  untiring.    Such  energy 
can  be  explained  only  on  the  basis  of  good  assimilative 
power  and  high  vitality,  as  seems  to  be  indicated  also  by 
his  resistence  to  high  fevers  and  by  his  bluntness  of 
nerve  which  enable  him  to  recover  rapidly  from  terrible 
injuries. 

This  economy  of  expenditure  has  a  very  important 


m 


24        HEALTH  AND  SOCIAL  PROGRESS 

effect  upon  the  development  of  the  higher  faculties.  When 
there  is  little  or  no  friction  in  the  organism  and  assimi- 
lative powers  are  good  and  work  is  not  too  exhausting,  a 
surplus  of  energy  is  easily  produced.     This  energy  can 
be  used  for  experimentation  along  various  lines,  either 
through  play  or  through  more  serious  attempts  at  inven- 
tion in  abstract  thinking,  imagination,  and  actual  recom- 
bination of  mechanical  contrivances.    There  is  no  need 
to  discuss  the  theory  of  play  here ;  ♦  suffice  it  to  say  that 
a  certain  amount  of  unused  energy  must  exist  in  the 
organism  if  play  is  to  be  indulged  in.    No  doubt  instinct 
directs  play  along  certain  lines,  and  nature  selects  only 
animals  which  play  efficiently  and  which  thus  prepare 
themselves  better  for  the  more  serious  duties  of  adult 
life — but  no  animal  or  human  being  will  play  when  fully 
exhausted.    He  may  fight  his  teasing  friends  with  his  last 
ounce  of  strength  for  the  right  to  rest  or  sleep,  but  he  will 
not  play.    He  may  change  his  occupation  from  reading 
to  walking,  and  thus  rest  his  tired  eyes  and  brain  while 
exercising  his  unused  legs,  but  when  he  is  tired  all  over, 
he  will  rest  if  he  possibly  can.    If  he  attempts  to  force 
himself,  the  result  is  as  a  rule  pitiful.    We  are  familiar 
with  the  official  smile  and  joke  at  the  President's  re- 
ception—and  elsewhere— with   its  mirthless  laugh  and 
forced  friendliness.     It  deceives  only  the  gushing  girl 
who  cannot  distinguish  between  spontaneous  humor  as 
the  result  of  abundant  vitality  and  the  make-believe  in- 
terest of  a  tired  man  who  wants  and  ought  to  be  in  bed. 
This  surplus  energy  enables  those  who  direct  it  properly 
to  develop  both  mentally  and  physically,  and  leads  thus 
to  an  enrichment  of  life  with  the  possibility  of  arriving 
at  new  and  possibly  useful  variations.     The  theory  of 
the  leisure  class  in  social  science  is  based  on  such  a 
surplus.     It  is,  however,  not  so  much  a  greater  supply 


MEANING  OF  HEALTH 


25 


of  goods  than  is  needed  for  the  maintenance  of  life,  as 
it  is  a  greater  amount  of  vitality  for  the  ordinary  duties 
of  life,  that  is  of  real  importance.  It  is,  in  other  words, 
not  so  much  a  question  of  wealth  as  the  economists  and 
sociologists  would  maintain,  as  it  is  a  question  of  health. 
This  may  be  proved  briefly  in  two  ways.  A  rich  patient 
confined  to  bed  more  or  less  all  his  life  consumes,  but 
rarely  creates  wealth,  while  a  poor  man  with  surplus 
energy  will  study,  write,  experiment,  and  produce  some- 
thing beneficial  for  society.  Again,  the  fact  that  many 
inventors  have  come  from  the  better  class  mechanics  and 
that  many  discoveries  have  been  made  by  teachers  in  col- 
leges and  universities  is  explained  better  on  the  theory  of 
health  than  on  that  of  wealth.  For  after  all,  there  is 
nothing  that  interests  the  man  of  low  vitality  except  his 
own  condition,  and  he  could  not  as  a  rule  make  use  of 
extant  knowledge  as  a  basis  for  extending  it,  even  if  he 
would.  Why  not?  Because  such  men  do  not  develop 
any  surplus  energy.  A  brief  consideration  will  make 
this  dear. 

We  have  seen  that  even  a  less  serious  defect  in  one  or 
another  organ  causes  the  whole  organism  to  divert  its 
energy  toward  the  ailing  part  and  interferes  thus  with 
its  general  functions  of  being  a  good  working  machine 
for  the  mind.  To  give  one  more  illustration.  Adenoids 
are  not  a  serious  defect  in  themselves.  Yet  this  slight 
derangement  of  normal  breathing  may  have  serious  ef- 
fects upon  the  mentality  of  a  child,  because  it  diverts 
the  functions  of  the  body  from  their  usual  and  mutually 
helpful  character  to  a  particular  organ  in  order  to  remove 
the  obstruction.  The  organism  becomes  thus  self-cen- 
tered, so  to  say,  instead  of  being  an  unconscious  agent 
of  the  mind.  That  means  that  no  surplus  energy  can  be 
developed   while  the  obstruction  lasts,  since  whatever 


26        HEALTH  AND  SOCIAL  PROGRESS 

energy  is  developed  goes  first  of  all  into  the  main- 
tenance of  the  vegetative  functions,  and  secondly  into 
the  removal  of  the  obstruction.  The  body  as  a  whole 
is  thus  not  properly  nourished.  This  explains  on  the 
one  hand  the  proverbial  fertility  of  the  poorly  nourished 
part  of  the  population,  since  nature  is  bent  on  the  con- 
tinuation of  life  at  all  costs  and  every  ounce  of  surplus 
energy  is  turned  into  reproductive  activities ;  on  the  other, 
the  many  cures  which  the  organism  effects  without  medi- 
cal aid,  since  it  must  work  with  the  least  friction  possible 
and  as  a  whole,  if  it  is  to  work  well.  But  some  parts 
must  suffer  from  this  under-nutrition.  The  nervous  sys- 
tem and  the  brain  are  the  ones  which  do  not  receive 
proper  nourishment  under  these  conditions.  They  are 
kept  at  the  lowest  minimum  possible  for  regulating  the 
organism ;  but  they  cannot  be  alert,  accurate,  and  aggres- 
sive: neither  can  they  be  finely  wrought  and  sensitive. 
The  associative  centers  or  the  cortex  suffer  most  from 
this  lack  of  proper  nutrition,  hence  they  cannot  exercise 
the  necessary  control  over  the  body,  and  the  latter  acts  in 
an  erratic  manner;  that  is,  without  properly  valuing  its 
actions  in  proportion  to  their  importance  to  the  organism 
as  a  whole.  Lack  of  unity  of  action  is  the  result,  and 
mentality  remains  at  a  comparatively  low  level.  It  is 
evident  that  a  person  in  that  condition  is  unable  even  to 
organize  new  information  received,  or  much  less  to 
originate  anything  new  by  recombining  the  elements  of 
knowledge  already  in  his  possession. 

It  is  different  with  people  in  good  health.  Just  because 
they  are  well  nourished,  the  brain  has  at  least  an  oppor- 
tunity to  be  kept  in  proper  condition  owing  to  the  surplus 
energy  of  the  organism.  Whether  an  individual  will  use 
that  energy  for  building  up  his  brain  or  his  muscle,  is,  of 
course,  a  different  question.    He  may  prefer  to  exercise 


MEANING  OF  HEALTH 


27 


his  muscles  and  build  up  an  athletic  body,  or  to  use  his 
brain  more  and  perfect  its  functions.     Whichever  he 
does,  the  law  of  the  growth  of  the  most  used  part  holds, 
and  that  part  will  develop  correspondingly  in  power.    If 
it  is  the  brain  he  exercises  most,  its  ability  to  form  new 
adaptations  and  combinations  quickly  and  accurately  will 
increase,  and  the  individual  may  contribute  something 
new  to  society.     The  question  whether  there  is  an  in- 
crease in  the  mass  of  the  brain  through  exercise  is  not 
yet  definitely  settled ;  the  increase  in  power  by  means  of 
more  numerous  and  better  organized  association-paths 
is,  however,  undisputed.     It  seems  a  natural  inference 
that  a  higher  brain  power  draws  more  nutrition  from  the 
body  as  a  whole.    Whether  that  is  true,  is  still  unsettled ; 
experience  seems  to  point  that  way,  since  people  with 
massive  brains— finely  organized  and  capable  of  much 
hard  work— rarely  belong  to  the  high  vitality  class,  but 
usually  to  the  medium,  according  to  Professor  Giddings.* 
The  body  of  the  great  thinker  is,  in  other  words,  organ- 
ized for  action  along  a  particular  line— that  of  mental 
exertion  in  poetry,  art,  philosophy,  science,  statesmanship, 
administration,  or  similar  vocations  where  facts  have  to 
be  seen  from  a  new  angle  or  to  be  classified  under  new 
generalizations. 

We  have  thus  far  considered  chiefly  the  lack  of  proper 
power  of  action  of  the  organism  due  to  more  or  less 
serious  illness  or  defect.  In  each  case  the  body  was 
deficient  through  the  self-assertion  of  some  organ.  Mal- 
nutrition has  the  same  effect,  but  more  continuously. 
The  body  in  that  case  is  unable  to  supply  the  various 
parts,  particularly  the  brain,  with  proper  power,  and 
hence  the  whole  organism  suffers  from  inability  to  act 
properly  and  efficiently.  And  just  as  the  sick  man  be- 
comes self-centered,  so  does  the  man  of  low  vitality. 


>1k 


['Ml 


28        HEALTH  AND  SOCIAL  PROGRESS 

He  is  continually  conscious  of  his  inability  to  adapt  him- 
self to  new  conditions  and  is  reminded  of  his  failures. 
His  mental  attitude  is  self-centered ;  he  looks  inward,  not 
outward ;  he  is  always  concerned  with  himself,  and  must 
of  necessity  be  so,  as  long  as  his  body  is  an  inapt  agent  of 
the  mind.  A  healthy  man  is  as  a  rule  a  social  man ;  a 
sick  one  is  usually  unsocial.  If  a  well  man  is  self- 
centered,  he  is  so  deliberately ;  but  one  in  poor  health  is  so 
by  necessity,  since  he  is  always  conscious  of  the  limita- 
tions of  his  body. 

Sickness  or  malnutrition  may,  however,  happen  to  a 
whole  race.    Many  savage  tribes  and  many  poor  classes 
among  civilized  nations  suffer  from  the  latter  defect  and 
are  unable  to  rise  to  a  higher  mental  life  because  of 
poorly  nourished  brains,  or  to  a  higher  social  level  owing 
to  the  inherent  social  limitations  of  men  of  low  vitality. 
The  larger  part  of  mankind  has,  however,  suffered  from 
diseases  of  various  kinds.     If  these  were  malignant  or 
epidemic,  men  died,  and  only  the  strongest  remained.    If 
they  were  benign  and  endemic,  a  gradual  deterioration 
took  place,  since  just  as  in  a  serious  illness  the  energy 
of  the  organism  is  diverted  from  its  proper  uses  to  the 
repairing  of  "broken  down  ramparts,"  so  in  endemic 
diseases  there  is  a  constant  endeavor  merely  to  ward  off 
danger  and  to  build  fortifications  against  invading  ene- 
mies.   Among  nature-peoples  malnutrition  and  endemic 
diseases  often  combine,  and  the  organism  is  unable  to 
resist  the  double  strain.    Hence  hundreds  of  tribes  have 
succumbed,  and  only  a  few  have  survived.    These  were 
generally  so  exhausted  from  the  struggle  that  their  power 
of  resistance  was  very  small,  and  any  new  disease  that 
might  be  introduced  would  kill  them.    Whether  as  in- 
dividuals or  as  a  race,  people  with  low  vitality  have  poorly 
nourished  brains,  small  power  of  adaptation  and  any  new 


MEANING  OF  HEALTH 


29 


strain  or  exigency  will  upset  them  completely;  hence 
they  either  perish  or  spend  proportionately  so  much 
energy,  that  a  more  serious  exhaustion  results,  and  this 
prepares  the  way  for  a  further  loss  of  power  of  re- 
sistance, since  there  is  no  way  to  create  surplus  energy. 
Whether  in  the  case  of  the  individual  or  in  that  of  a 
race,  low  vitality  produces  an  attitude  which  centers 
in  the  individual  rather  than  in  society. 

High  vitality  produces,  as  a  rule,  social  action.  "  The 
natural  glowing  fire  of  health— superb  health— is  seen  and 
felt.  It  is  magnetic.  It  makes  for  itself  place  and  fol- 
lowing. It  is  constructive.  It  is  initiative.  It  is  happy. 
It  is  humane.  It  is  beautiful.  It  radiates  strength  and 
brightness.  It  agitates  for  the  good  of  others.  It  com- 
pels pleasantly  to  be  and  do  one's  best." «  There  is  an 
expansive  quality  about  good  health  which  we  realize  only 

when  in  the  presence  of  a  man  abounding  in  vitality 

good-natured  and  buoyant.  Such  a  man  is  always  master 
of  himself,  because  he  is  unconscious  of  his  body.  Not 
having  any  ills  of  his  own,  he  is  happy,  and  his  happiness 
is  contagious,  because  it  is  spontaneous.  He  not  only 
radiates  peace  and  contentment,  but  wants  to  see  others 
happy  and  cheerful.  Being  always  master  of  himself, 
he  is  tactful  and  spares  the  feelings  of  others.  If  he  has 
the  gift  of  humor — as  he  usually  does— it  is  good-natured 
and  not  sarcastic  or  sardonic  like  that  of  the  dyspeptic 
who  trusts  nobody  because  he  is  not  sure  of  his  own 
power.  The  healthy  man  wants  a  well-ordered  environ- 
ment, since  his  own  mind  and  body  make  a  harmonious 
whole.  He  generally  succeeds,  too.  For  he  who  is 
master  of  himself  is  best  able  to  bring  order  out  of  chaos 
among  those  around  him.  He  has  few,  or  no,  troubles  of 
his  own,  and  his  abounding  energy  seeks  an  outlet  in 
helping  others.    His  whole  activity  is  directed  outward 


30 


HEALTH  AND  SOCIAL  PROGRESS 


MEANING  OF  HEALTH 


31 


>« ) 


m 


toward  conquering  difficulties  which  he  attacks  with  zest 
and  vigor  because  they  furnish  good  practice  for  his 
various  powers.  He  is,  in  other  words,  not  merely  moral, 
but  social,  for  sociality  rises  above  morality. 

**  Objectively  viewed,  morality  consists  of  that  '  walk  and 
conversation '  which  the  community  as  a  whole  approves.  It 
includes  not  only  acts,  well  adapted  to  the  achieving  of  those 
ends  that  on  the  whole  are  held  to  be  good,  but  also  outward 
expressions  of  thought  and  feeling,  so  far  as  these  are  ap- 
proved. Subjectively,  morality  is  self-respect,  and  that  desire 
for  the  good  opinion  of  others,  and  that  endeavor  to  deserve 
it,  which  Mr.  Spencer  has  called  ego-altruism.  .    .    . 

"  As  the  name  itself  implies,  sociality  comprises  those  quah- 
ties  of  mind  and  character,  of  disposition  and  conduct,  which 
are  eminently  and  characteristically  social. 

"  Objectively  viewed,  sociality  is  a  cheerful  and  efficient  par 
ticipation  in  the  normal  comradeship  and  cooperation  of  society. 

**  Subjectively  viewed,  sociality  is  altruism — thought  fulness  for 
others,  sympathy  with  others,  kindliness  and  helpfulness  toward 
others,  even  at  some  cost  of  self -sacrifice,  and  happiness  in  the 
companionship  of  one's  kind."  ^ 

A  person  with  low  vitality  may  be  moral ;  by  precept 
and  training  he  may  be  able  to  overcome  the  tendencies 
toward  self-centering  activities  to  which  he  is  naturally 
inclined ;  but  it  takes  a  positive,  and  sometimes  a  strong, 
effort  to  do  so.  This  fact  is  well  and  frequently  illus- 
trated by  numerous  people  who,  cursed  with  a  low  vital- 
ity, sometimes  make  herculean  efforts  to  reform,  only  to 
backslide  after  many  failures.  They  may  be  charged  with 
moral  delinquency  or  even  depravity;  but  the  blame  for 
their  failures  should  be  laid  at  the  door  of  low  bodily 
vigor  or  some  physical  defect.  Where  vitality  is  some- 
what higher,  we  still  have  only  a  limited  morality.  A 
rich  person  may  refrain  from  definitely  unsocial  or  im- 
moral acts ;  he  may  even  give  from  the  abundance  of  his 


possessions  to  poorer  people  out  of  self-respect  or  to 
maintain  the  good  opinion  of  others ;  but  he  cannot  give 
cheer,  hope,  buoyancy,  and  efficient  service,  because  he 
needs  whatever  strength  he  has  for  himself.  The  sour- 
faced  man  may  solemnly  declare  in  a  prayer  meeting  that 
he  loves  his  f ellowman  with  his  whole  soul,  but  the  fulfill- 
ment of  his  promise  is  not  in  his  power,  since  in  his  case 
the  spirit  may  be  willing  but  the  flesh  is  literally  weak; 
and  no  man  can  give  what  he  does  not  have.  It  is  the 
same  way  in  larger  matters.  A  person  of  low  vitality 
may  be  willing  to  lay  down  his  life  for  his  country;  he 
will  not  go  far  before  he  is  in  need  of  Red  Cross  nurses. 
The  Athenian  of  the  times  of  Philip  of  Macedon  avowed 
his  patriotism  in  the  strongest  possible  terms,  but  Demos- 
thenes informs  us  that  Athens  talked  about  hiring  10,000 
or  20,000  soldiers ;  for  this  malaria-ridden  Athenian  could 
not  take  the  field  like  his  ancestor  of  the  previous  century. 
He  was  not  a  hypocrite  in  protesting  his  love  for  Athens, 
while  preferring  to  stay  at  home;  he  simply  could  not 
take  the  field  owing  to  low  vitality.  Lack  of  health  al- 
ways confines  one's  good  intentions  within  narrow  limits. 


■ 


.    HEALTH  AND  RELIGION 


33 


!i."t 


CHAPTER  III 

HEALTH  AND  REUGION 

Whether  the  origin  of  religion  is  to  be  attributed  to  fear 
as  with  Lucretius,  to  a  feeling  of  dependence  as  with 
Schleiermacher,  to  the  dread  of  ghosts  as  with  Spencer,  to 
awe  before  the  Great  Dreadful  as  with  Giddings,  or  to 
other  less  definite  qualities  of  modern  theorists,  there  is 
ultimately  just  one  thing  back  of  them  all — an  attitude  of 
helplessness  on  the  part  of  man  to  do  what  is  necessary 
or  desirable.  This  goes  back  to  low  vitality,  if  not  to 
poor  health.  A  man  may  be  ignorant  and  not  trouble 
himself  about  the  explanation  of  things.  But  if  he  is 
well,  he  will  be  able  to  satisfy  the  few  wants  which  primi- 
tive man  feels.  Fear  is  apt  to  grip  the  weak  man  who  is 
left  behind  and  is  unable  to  provide  for  himself,  but  not 
the  hunter  or  the  warrior  who  delights  in  action.  It  was 
the  "  squaw  man,"  roughly  speaking,  who  had  time,  and, 
maybe,  good  reason  to  begin  crude  speculations  on  how 
to  escape  his  often  intolerable  position,  and  who  has 
expressed  his  attitude  in  all  the  earlier  or  negative  re- 
ligions. 

The  limitations  imposed  by  poor  health  have  been  the 
cause  of  our  slow  advance  in  civilization.  We  have 
progressed  only  in  a  self -centered  manner.  Our  religious 
and  our  moral  codes  are  all  self -centered,  and  could  not  be 
otherwise  under  past  and  present  conditions.  In  the  past 
man  has  always  sought  merely  relief  from  evil.  This 
has  given  our  morality  an  almost  purely  negative  char- 
acter, and  to  our  civilization  one  of  pessimism.     For 

32 


civilization  was  dominated  by  religion,  and  we  have  not 
yet  fully  escaped  from  its  negative  ideal. 

What,  then,  is  the  ideal  of  religion  ?  Relief !  Which- 
ever way  we  turn,  the  various  forms  of  religion  always 
have  to  do  with  that.  It  is  either  relief  from  physical 
dangers,  or  from  spiritual  enemies,  or  from  ourselves, 
that  is  sought.  Whether  we  are  told  that  sickness  is  a 
visitation  from  God,  or  that  evil  power  may  tempt  us, 
or  that  individuality  itself  is  evil  and  that  we  must  seek 
coalescence  with  the  infinite  in  Nirvana,  it  is  always  re- 
lief that  is  held  up  before  us,  i.e.,  a  purely  negative  ideal 
— ^an  ideal  in  other  words,  which  was  conceived  by  and 
intended  for  sick  people,  or  at  least  those  of  low  vitality. 
Such  an  ideal  is  essentially  self-centered.  The  religious 
man  whose  chief  concern  is  to  save  himself,  is  still  acting 
only  morally  and  not  socially,  for  he  is  occupied  princi- 
pally with  himself.  This  fact  is  strikingly  illustrated  in 
the  various  monastic  ideals  which  plainly  inculcate  as  the 
first  duty  salvation  of  oneself — expressed,  however,  in 
the  more  euphemistic  terms  of  love  and  service  toward 
God.  The  Golden  Rule,  whether  in  the  negative  form  of 
Confucianism  or  in  the  positive  of  Christianity,  is  a 
self-centered  principle,  since  action  is  based  on  self- 
regard,  one  might  ahnost  say,  of  personal  advantage. 
The  chief  virtue  of  Christianity  is  charity — relief  from 
distress;  and  its  principal  form  is  almsgiving — "laying 
up  treasures  for  yourself  in  heaven." 

Is,  then,  the  religious  or  charitable  man  selfish  ?  Not  at 
all.  He  has  a  finely  organized  nervous  system  for  feeling 
pain  and  suffering,  and  is  therefore  often  more  sympa- 
thetic in  the  literal  sense  than  well  people  sometimes  are. 
This  is  significantly  expressed  by  the  fact  that  the  older 
form  of  charity  almost  confined  itself  to  the  relief  of 
pain  and  suffering.    That  gives  it  a  certain  social  value 


m 


34        HEALTH  AND  SOCIAL  PROGRESS 

and  ethical  character.    It  does  not,  however,  relieve  sym- 
pathy  from   its   fundamental   character  of   being  self- 
centered,  since  the  sympathetic  pain  experienced  by  the 
almsgiver,  or  the  possible  reward  of  almsgiving,  are  at 
least  subconsciously  motives  to  action.    This  could  hardly 
be  different  under  a  civilization  whose  characteristic  fea- 
ture was  suffering— politically,  from  oppression,  hence 
submission  to  duty ;  economically,  from  constant  deficits 
as  proved  by  numerous  famines,  hence  the  worship  of 
various  deities,  like  Ceres,  who  were  supposed  to  give 
bountiful    harvests;   physically,    from    almost   constant 
diseases   and    under-feeding,    hence    the    low    tone    of 
morality  based  chiefly  on  utilitarianism  of  a  narrow  type. 
The  whole  object  of  life  was  one  continuous  attempt  on 
the  part  of  the  individual  and  society  to  escape  from 
intolerable  conditions.     Is  it  any  wonder  that  morality 
was  not  and  could  not  be  buoyant  and  social,  but  had  to 
be  negative  and  sel f -centered  ?    Uncertainty  what  the  day 
might  bring  forth  politically,  economically,  or  for  personal 
well-being,  kept  the  people  in  constant  turmoil  and  made 
them  think  of  themselves  and  their  safety  of  life  and 
property.    At  such  a  time  the  relief  of  siiflFering  was  of 
necessity  a  great  virtue,  since  the  individual  was  unable 
to  think  of  others,  even  though  reminded  that  he  himself 
might  soon  need  help.    Take  as  an  illustration  the  treat- 
ment of  slaves.    It  was  on  the  whole  good,  not  primarily 
for  economic  reasons,  but  chiefly  for  sympathetic  reasons, 
since  in  the  constant  political  changes  no  one  knew  who 
might  be  a  slave  tomorrow  even  though  he  be  a  master 
today.     In  the  constant  political  changes,  empires  were 
often  overthrown  during  a  few  days,  and  the  ruler  of 
today  might  be  dragged  behind  the  chariot  of  a  victorious 
enemy  tomorrow,  irrespective  of  whether  he  came  from 
within  or  from  without.    Even  the  proudest  nations  of 


HEALTH  AND  RELIGION 


35 


antiquity  were  sooner  or  later  reduced  to  a  x:ondition  of 
servitude,  and  some  of  the  greatest  men  suflFered  the 
humiliation  of  being  made  the  butt  of  vulgar  remarks  on 
the  part  of  the  victorious  mob. 

A  few  words  may,  perhaps,  be  necessary  here  to  avoid 
misunderstanding  in  regard  to  the  moral  ideals  of 
Christianity.  The  statement  has  just  been  made  that  its 
morality  was  self-centered.  This  is  true  as  far  as  its 
de  facto  statements  are  concerned.  The  Golden  Rule, 
while  a  good  principle  for  a  narrow  morality,  is  neverthe- 
less self-centered  and  only  incidentally  social,  since  the 
individual  is  asked  to  act  or  refrain  from  action  on  the 
basis  of  the  eflFect  it  would  have  on  him;  this  rule  in- 
volves, consequently,  a  calculation  of  ultimate  effects. 
But  this  is  exactly  what  a  man  of  low  vitality  always  does 
and  has  to  do.  Being  always  conscious  of  his  limitations, 
he  must  ask  himself  what  the  ultimate  effects  of  his 
actions  will  be.  And  he  does  that  even  while  his  vitality 
is  still  fair.  A  man  like  Cassius  with  his  "lean  and 
hungry  look  "  always  thinks  too  much  about  himself,  and 
never  rises  above  that  level  in  his  ethical  motives ;  neither 
does  the  average  man  who  is  firmly  convinced  that  "  hon- 
esty is  the  best  policy."  When  a  man's  vitality  has  sunk 
lower  still  and  he  has  become  more  self-conscious,  he  acts 
from  more  narrowly  selfish  motives ;  i.e.,  he  schemes  with 
great  cunning  to  get  what  he  wants ;  or  in  a  blind  rage, 
when  a  particular  organ  has  become  the  center  of  his 
gravitation  and  is  uncontrolled  by  the  brain,  he  goes  ahead 
and  takes  what  he  wants.  This  man  of  lower  vitality 
acts  in  a  decidedly  unethical  manner,  while  the  other, 
still  able  to  calculate,  may  keep  within  the  limits  of  the 
permissible.  This  is,  however,  not  social  action,  be- 
cause it  is  too  largely  self-centered.  True  social  action 
can  come  only  from  an  abundance  of  vitality,  plenitude 


(T 


56 


HEALTH  AND  SOCIAL  PROGRESS 


HEALTH  AND  RELIGION 


37 


of  power,  and  the  happiness  of  high  tension.  Such  a  man 
must  act  because  he  has  a  desire  for  function;  and  he 
must  act  socially,  because  his  actions  are  not  self- 
centered;  he  is  usually  unconscious  of  his  body.  He  is 
full  of  joy  and  confidence,  and  imparts  these  to  others 
— not  deliberately,  but  because  these  qualities  are  con- 
tagious. When  he  becomes  clearly  conscious  of  these 
powers,  he  recognizes  that  they  involve  a  responsibility, 
and  he  deliberately  controls  his  actions  in  such  a  manner 
as  not  only  to  avoid  harm,  but  to  increase  joy  and  happi- 
ness among  his  f  ellowmen.  He  inverts  Kant's  categorical 
imperative,  and  says  to  himself :  Thou  must,  because  thou 
canst !  no  matter  what  others  may  do. 

It  seems  to  me  that  the  true  ideals  of  Qiristianity  are 
identical  with  those  of  the  healthy  man.  When  Christ 
said :  "  For  this  purpose  have  I  come  into  the  world  that 
they  might  have  life,  and  have  it  more  abundantly,"  or 
when  we  are  admonished  to  become  "  co-workers  with 
God"  (I  Cor.  3:9),  we  have  a  positive  ideal  placed 
before  us ;  an  ideal  not  only  moral  because  such  action  is 
best,  but  social  because  the  abundance  of  life  and  power 
within  us  seeks  an  outlet  in  action  which  is  wholesome 
and  implies  cooperation  with  God — the  source  of  all  be- 
neficent power  according  to  Christian  teaching. 

Unfortunately  this  positive  ideal  has  never  had  much 
sway  in  Christian  ethics,  and  could  not  have  under  the 
universally  prevailing  conditions  of  low  vitality.  When 
everybody  has  less  vitality  than  his  own  needs  demand, 
individuals  as  well  as  societies  must  form  ethical  codes  of 
a  negative  character  or  a  narrow  morality,  based 
primarily  on  utilitarian  principles,  such  as  the  Golden 
Rule.  With  increasing  health  through  better  food  and 
better  control  of  germ  diseases,  such  a  code  proves  in- 
creasingly less  satisfactory.     Men  in  good  physical  and 


mental  health  want  positive  action,  not  merely  escape 
from  evil  or  from  illness,  since  they  are  not  conscious  of 
any  lack  of  power  as  the  ill  or  underfed  man  always 
is.  They  are  confident  and  self-reliant,  and  feel  capable 
of  coping  with  the  difficulties  in  their  path ;  indeed,  they 
rejoice  in  matching  their  physical  and  mental  strength 
against  obstacles.  If  this  theory  is  true,  it  ought  to  ex- 
plain three  facts  in  the  modem  world — declining  church 
attendance  among  more  vigorous  men,  continued  attend- 
ance among  the  less  vigorous,  and  the  separation  of  phil- 
anthropic movements  from  the  churches. 

That  church  attendance  is  declining,  is  almost  a  uni- 
versal complaint  among  the  clergy,  and  the  fact  that 
various  devices  are  adopted  to  attract  men,  furnishes  the 
proof  for  its  truth.  These  absentees  are,  however,  no 
longer  considered  wicked,  or  even  atheistic,  for  many 
good  and  capable  citizens  belong  to  this  class.  They  will, 
moreover,  send  their  wives  and  children  to  church  or 
Sunday-school,  give  money  toward  its  maintenance,  and 
perhaps  admit  its  necessity.  What,  then,  is  the  reason 
for  their  non-attendance?  It  is  not  hostility,  but  simply 
a  lack  of  interest  in  what  the  church  offers.  It  oflFers 
them  help,  but  they  do  not  feel  any  need  of  it ;  it  proffers 
relief,  but  they  are  whole;  it  promises  forgiveness,  but 
they  have  no  sense  of  sin.  In  short,  the  church  proposes 
to  give  them  what  they  believe  they  already  have.  They 
are,  or  think  they  are,  able  to  look  after  themselves,  and 
are  confident  that  if  they  do  all  in  their  power  to  make 
the  world  better,  they  will  be  taken  care  of  in  the  here- 
after. They  favor  church  attendance  for  others,  but  feel 
no  need  for  it  themselves.  All  the  various  attempts  to 
interest  them  seriously  and  personally  fail,  because  no 
positive  action  is  demanded  of  them.  Hence  many 
churches  have  adopted  the  device  of  giving  these  men 


38        HEALTH  AND  SOCIAL  PROGRESS 

something  specific  to  do — ^to  organize  a  boys'  club,  teach 
a  class  of  unmanageable  boys,  look  after  some  weaker 
brothers,  and  other  things ;  but  the  interest  lasts  only  as 
long  as  the  task  is  unfinished,  since  they  feel  that  religion 
as  constituted  in  the  past  and  largely  at  present,  is  based 
on  the  acceptance  of  something  which  they  claim  to  pos- 
sess— wholeness.  Fortunately  the  church  begins  to 
realize  that  these  most  valuable  men  have  to  be  treated 
differently  and  a  field  for  positive  action  is  now  offered 
to  them  along  various  lines. 

Church  attendance  is  still  good  on  the  part  of  less 
vigorous  men  who  feel  the  need  of  every  possible  as- 
sistance in  their  effort  to  become  strong.  It  is  this  par- 
ticular class  which  is  intensely  religious  at  times,  just 
because  it  is  aware  of  its  own  instability  and  lack  of  self- 
mastery,  due  to  low  vitality.  In  his  discussion  of  the 
religious  temperament  Sir  Francis  Galton  says: 

"The  result  of  all  these  considerations  is  to  show  that  the 
chief  peculiarity  in  the  moral  nature  of  the  pious  man  is  its 
conscious  instability.  He  is  liable  to  extremes— now  swinging 
forward  into  regions  of  enthusiasm,  adoration,  and  self-sacrifice ; 
now  backward  into  those  of  sensuality  and  selfishness.  Very 
devout  people  are  apt  to  style  themselves  the  most  miserable 
of  sinners,  and  I  think  they  may  be  taken  to  a  considerable 
extent  at  their  word.  It  would  appear  that  their  disposition 
is  to  sin  more  frequently  and  to  repent  more  fervently  than 
those  whose  constitutions  are  stoical  and  therefore  of  a  more 
symmetrical  and  orderly  character.  The  amplitude  of  the  moral 
oscillations  of  religious  men  is  greater  than  that  of  others  whose 
average  moral  position  is  the  same."* 

It  is  in  harmony  with  this  reasoning  to  find  that  the 
most  orthodox  churches  are  the  only  ones  that  grow, 
because  they  promise  the  weak  man  every  possible  help. 
Wh^n  seeking  relief  from  his  own  instability,  a  man  will 


HEALTH  AND  RELIGION 


39 


not  stop  to  inquire  into  the  ability  to  make  valid  the  claim 
of  assistance,  but  grasp  at  any  proffered  aid.  The  in- 
cantations of  the  medicine  man  are  as  good  for  this 
purpose  as  the  unintelligible  philosophy  of  so-called 
Christian  Science,  which  owes  its  rapid  extension  pri- 
marily to  its  ability  to  cure  people  from  imaginary  ills  and 
has  received  into  its  membership  chiefly,  if  not  exclu- 
sively, those  who  sought  relief  from  some  ailment.  Many 
articles  have  been  written  on  church  attendance;  but  the 
fact  remains  that  the  denominations  which  promise  most 
in  the  way  of  relief  are  increasing  more  rapidly  than 
others  which  demand  work.* 

The  separation  of  philanthropic  movements  from  the 
churches  is  increasing  constantly.  Not  so  very  long  ago 
the  church  was  the  only  agency  which  administered  relief 
to  the  various  kinds  of  afflicted  people.  Now  the  State 
has  taken  up  that  function  to  a  large  extent,  and  numer- 
ous semi-public  organizations  look  after  every  possible 
need.  It  may  be  said,  with  good  reason,  that  the  church 
initiated  most  of  these  movements,  that  they  are  still 
managed  chiefly  by  religious  people,  and  that  it  is  not 
her  function  to  do  the  work  of  the  community.  All  this 
is  true.  Yet  it  is  significant  that  the  church  has  failed 
to  keep  these  men  and  movements  within  her  borders  in 
all  countries  except  Belgium  and  the  Roman  Catholic 
part  of  Germany,  where  the  work  is  chiefly  that  of  relief. 
Under  the  guidance  of  modern  philanthropy,  assistance  to 
those  in  "  need,  sorrow,  sickness,  or  any  other  adversity," 
has  not  only  passed  from  the  church,  but  has  changed  in 
character;  it  aims  primarily  at  prevention  instead  of 
cure,  hence  the  innumerable  movements  to  make  people 
more  intelligent,  more  moral,  and — more  healthy.  The 
public  baths,  the  play-grounds,  the  medical  attention  for 
school  children,  the  school  luncheons,  the  shorter  hours 


# 


40         HEALTH  AND  SOCIAL  PROGRESS 

for  factory  employees,  the  improved  sanitary  conditions 
in  the  factories,  the  larger  wages — all  tend  to  better 
health,  although  perhaps  unconsciously  on  the  part  of 
those  who  promote  them,  since  health  has  not  yet  been 
recognized  in  all  its  bearings.  The  reason  for  this  change 
in  philanthropy  is  not  far  to  seek. 

Well-doing  does  not  come  to  the  social  man  as  a  duty, 
but  rather  as  an  opportunity  to  exercise  his  powers,  which 
he  delights  to  do ;  hence  he  is  not  satisfied  with  the  relief 
which  has  to  be  repeated  tomorrow.  He  looks  into  the 
future,  because  his  abundant  vitality  prompts  him  to 
devise  ways  and  means  for  increasing  joy  in  the  world ; 
and  this  attitude  leads  inevitably  to  prophylactic  meas- 
ures. The  older  civilization  was  characterized  by  the 
saying:  "Sufficient  unto  the  day  is  the  evil  thereof," 
because  it  could  not  possibly  cope  with  other  than  im- 
mediate needs ;  the  newer  joyfully  takes  up  the  fight  for 
the  future. 

This  is  truly  a  new  civilization,  since  in  every  direction 
we  see  prophylaxis  taking  the  place  of  cure — in  medicine, 
in  conservation  of  natural  resources  as  well  as  the  health 
of  human  beings,  in  the  lessening  of  human  toil  through 
machinery,  in  the  attempt  of  the  various  "Sunshine 
Societies  "  to  spread  joy  in  the  world.  It  is  perhaps  this 
attitude  of  modern  man  which  explains  the  strong  social- 
istic tendencies  both  among  the  rich  and  the  educated 
in  England  and  America,  since  socialism  offers  the 
most  complete  program  of  any  party  for  prophylaxis 
along  every  line,  and — oh,  how  a  healthy  man  hates 
patch  work;  he  would  rather  cut  out  of  the  whole 
cloth. 

This  new  attitude  is  possible  only  on  the  basis  of  better 
health,  i.e.,  freedom  of  action  through  surplus  energy, 
which  expresses  itself  in  all  kinds  of  experimentation. 


HEALTH  AND  RELIGION 


41 


The  old  attitude  was  conditioned  by  low  vitality,  because 
people  were,  and  perhaps  had  to  be,  self-centered,  since 
they  were  always  conscious  of  their  bodies;  hence  they 
had  to  content  themselves  with  preserving  what  they 
had,  and  to  ward  off  evils  or  seek  relief  from  them. 
They  lacked,  in  other  words,  aggressive  health,  and  con- 
sequently aggressive  mentality.  For  the  two  are,  to  a 
certain  extent  at  least,  identical.  The  modern  world  has 
generally  adopted  the  saying  of  the  classical  world,  mens 
sana,  in  cor  pore  sano;  but  what  was  formerly  only  an 
inference  from  observation  has  been  established  as  a 
scientific  truth  by  modem  medicine.  Almost  every  day 
produces  new  proofs  to  the  effect  that  a  poorly  nourished 
or  a  diseased  body  is  the  host  of  low  or  erratic  mentality. 
The  mind  of  a  healthy  man  need  not  be  that  of  a  genius ; 
it  is,  however,  balanced  and  open  to  all  good  influences, 
because  based  on  aggressive  vitality  which  seeks  an  outlet 
for  action.  But  an  active,  circumspect,  clear-visioned 
mind  is  more  important  from  a  social  and  economic  point 
of  view  than  the  acerbities  and  vituperations  of  a  great 
intellect,  clad  in  pompous  and  often  unintelligible  sen- 
tences. As  a  rule,  the  best  work  of  the  world  in  philos- 
ophy and  science  has  been  done  by  men  in  good  health. 
An  attempt  will  be  made  to  prove  this  statement  in  a 
later  chapter.  The  theory  of  mens  sana,  in  corpore  sano 
is,  moreover,  independent  of  any  particular  metaphysical 
doctrine.  If,  according  to  the  theory  of  parallelism,  body 
and  mind  are  independent,  the  body  is  still  the  medium 
through  which  the  mind  must  express  itself ;  if  the  ma- 
terialists should  be  right,  the  mind  would  be  merely  a 
special  product  of  matter,  and  would  be  dependent  on  the 
proper  functioning  of  the  organism;  if  the  idealists  are 
correct,  the  body  would  be  a  special  form  of  mind,  but 
still  its  only  known  agent  for  manifesting  itself.    Even 


w 


ff 


42 


HEALTH  AND  SOCIAL  PROGRESS 


the  idealist  Emerson  said :  "  Give  me  health  and  a  day, 
and  I  will  make  the  pomp  of  emperors  ridiculous."  * 

Lack  of  aggressive,  or  even  good  health,  has  had  an 
important  bearing  on  civilization,  since  man  has  nowhere 
risen  much  higher  than  savagery  where  conditions  were 
unfavorable  to  the  development  of  at  least  medium  vital- 
ity.   What  then  are  the  factors  of  good  health  ? 

♦The  change  from  the  old  to  the  new  religious  attitude  is 
strikingly  illustrated  in  the  history  of  the  Young  Men's  Chris- 
tian Assocation.  Not  long  since  its  diluted  evangelism  was 
looked  upon  with  mild  tolerance  by  the  more  vigorous  men  and 
women.  Then  a  genius,  discerning  the  signs  of  the  times, 
brought  about  a  change  to  an  active  and  aggressive  Christianity. 
At  once  the  Y.  M.  C.  A.  leaped  into  the  respect  and  admiration 
of  the  community,  as  is  shown  by  the  two  campaigns  for  money 
in  1917.  One  of  the  wealthiest  church  organizations  in  the 
U.  S.  finished  a  year's  active  compaign  for  a  pension  fund 
for  ministers,  and  raised  $8,000,000  instead  of  $5,000,000.  The 
Y.  M.  C.  A.  got  $53,000,000  in  a  week,  and  $7,000,000  more  in 
the  weeks  following.  Business  men  were  enthusiastic  about  its 
positive  and  practical  religion,  and  subscribed  liberally. 


CHAPTER  IV 

FACTORS  OF  HEALTH 

The  first  factor  of  health  is  food.  Nature-peoples  are, 
as  a  rule,  poorly  fed.  Their  meals  are  irregular,  generally 
poor  in  quality,  and  often  insufficient  in  quantity.  The 
roots,  berries,  and  other  foods  which  nature  furnishes, 
are  usually  poor  in  nutritive  qualities.  Hence  the  savage 
is  habitually  underfed,  since  the  system  is  starved  even 
though  large  quantities  of  coarse  food  be  taken.  This 
simply  means  that  the  digestive  organs  are  burdened  with 
material  which  does  not  nourish,  and  causes  a  distension 
of  the  abdomen,  as  may  be  witnessed  almost  anywhere 
among  the  poorer  classes  of  China,  India,  Turkey, 
Rumania,  Russia,  and  some  parts  of  Austria-Hungary, 
not  to  speak  of  countries  in  which  savagery  still  prevails. 
When  a  good  meal  can  be  had,  as  after  a  successful  hunt, 
the  savage  eats  voraciously  and  without  proper  mastica- 
tion ;  hence  digestion  is  interfered  with  in  a  different  way. 
The  system  is  in  a  chronic  state  of  starvation,  and  no 
proper  vitality  can  be  built  up.  This  fs  true  even  in 
civilized  countries  among  the  poorer  classes  whose  food 
supply  is  deficient  in  quality  and  quantity. 

The  second  factor  is  housing ;  that  is,  anything  that  is 
necessary  for  protection  against  the  inclemencies  of 
nature.  Little  clothing  may  be  needed  in  the  tropics 
owing  to  the  heat,  but  protection  is  necessary  against  the 
numerous  disease-carrying  insects.  The  Eskimo  is  well 
provided  in  regard  to  clothing,  but  his  igloo  or  snow-hut 
compels  him  to  live  in  vitiated  air  a  great  part  of  his 

43 


* 


44        HEALTH  AND  SOCIAL  PROGRESS 

life,  similar  to  the  overcrowding  in  the  tenements  of 
large  cities. 

The  third  factor  is  salubrity  of  climate.  Where  en- 
demic diseases  exist,  the  good  effects  of  food  and  housing 
are  often  nullified.  A  region  may  be  fertile  and  produce 
all  kinds  of  food,  the  climate  may  be  mild,  but  endemic 
diseases,  e.g.,  malaria  and  hookworm,  will  keep  vitality 
at  a  low  ebb. 

The  fourth  factor  is  heredity.  With  the  inheritance 
of  a  good  constitution  a  man  may  often  be  able  to  over- 
come the  adverse  conditions  of  the  other  factors,  although 
he  is  likely  to  keep  merely  alive  and  refuse  to  succumb. 
With  low  hereditary  vitality,  a  man  is  always  handi- 
capped, even  though  the  other  three  factors  be  favorable. 
This  is  proved  by  the  fact  that  life  insurance  companies 
will  refuse  policies  to  people  in  whose  families  certain 
diseases  have  occurred.  When  the  other  three  fac- 
tors are  unfavorable,  heredity  is  likely  to  be  very 
poor. 

The  question  concerning  the  relative  importance  of 
these  factors  is  not  decided,  and  is,  perhaps,  of  more 
academic  than  practical  interest.  Biology  is  apt  to  lay 
stress  on  heredity,  geography  on  environment,  including 
food,  climate,  and  housing.  These  two  factors  have  been 
on  the  whole  the  chief  agencies  in  developing  man. 
Heredity  has  been  the  variable  factor— shifting, 
plastic,  progressive,  or  retrogressive;  environment  has 
been  the  constant  factor— persistent,  continuous,  omni- 
present, immutable.  Man  is  always  under  the  influence 
of  his  environment;  it  never  sleeps.  Yet  all  the  influ- 
ences of  environment  will  not  explain  the  difference  be- 
tween the  Greeks  of  today  and  those  of  antiquity.  The 
human  factor  surely  claims  attention,  even  though  it  be 
floly  a  variable  influence  over  against  the  immutable  one 


FACTORS  OF  HEALTH  4S 

of  nature.  The  French  had  to  give  up  digging  the 
Panama  Canal,  because  malaria  and  other  tropical 
diseases  killed  about  one-quarter  of  their  employees  every 
year.  When  the  Americans  went  there  in  1905,  the  Canal 
Zone  was  still  the  area  of  pest-ridden  seaports,  jungles, 
and  marshes  which  it  had  been  from  time  immemorial' 
Yet  we  have  built  the  Canal  by  reducing  the  death  rate 
to  that  of  the  healthiest  cities  in  the  United  States.  The 
variable  human  factor  has  triumphed  over  the  immutable 
one  of  nature.  It  is  in  vain,  then,  to  deny  the  efficacy 
of  either  factor.  Each  plays  its  role  in  the  making  of 
human  history.  But  each  enters  into  the  problem  of 
health,  since  that  depends  on  both  heredity  and  environ- 
ment. 

Suppose  that  environment  be  granted  all  that  its  advo- 
cates claim !  Wherein  does  its  influence  ultimately  con- 
sist? A  valley  may  abound  in  the  most  varied  and  nour- 
ishing foods  and  in  perennial  sunshine;  it  will  yet  be 
uninhabitable  for  human  beings  if  its  soil  sends  forth  all 
kinds  of  poisonous  germs.  A  country  may  be  bleak  and 
cold,  still  people  will  live  there  if  they  are  able  to  provide 
the  minimum  of  food.  The  geographical  factor  resolves 
Itself  ultimately  into  one  of  health ;  and  this  has  been  the 
most  important  factor  in  man's  rise  above  the  state  of 
nature. 

The  effects  of  vitality  on  civilization  are  both  numer- 
ous and  significant.  Whatever  the  causes  may  be,  low 
vitality  means  either  low  or  erratic  mentality.  We  are 
concerned  here  only  with  the  former ;  the  latter  will  be 
considered  in  the  chapter  on  Health  and  Originality. 
Low  vitality  always  means  inability  to  adjust  oneself 
to  one's  environment,  or  to  control  it.  Even  adjustment 
to  unfavorable  conditions  implies,  however,  low  men- 
tahty;  the  animal  and  the  savage  are  ruled  by  their  en- 


46        HEALTH  AND  SOCIAL  PROGRESS 

vironment,  civilized  man  controls  it.     Why  this  differ- 
ence? 

Animals  have  perfected  certain  instincts  which  are,  as 
a  rule,  sufficient  guides  to  their  actions,  and  keep  them, 
when  in  a  normal  condition,  in  fair  health.  They  act 
with  almost  automatic  precision,  and  thus  save  the  ani- 
mal a  vast  amount  of  useless  expenditure  of  energy  in 
mere  trials  to  do  something  in  a  new  way.  But  just  be- 
cause the  reactions  of  animals  are  fixed,  progress  is 
barred  and  further  development  practically  impossible. 
The  honey  bee  is  a  good  illustration  in  this  respect.  It 
has  perfected  the  division  of  labor  and  everything  is 
provided  for  the  welfare  of  the  hive.  The  arrangements 
for  a  communal  life  excite  our  admiration  owing  to  their 
efficiency.  Yet,  there  is  no  progress,  because  the  various 
impulses  which  form  the  series  of  which  each  instinct 
consists  are  so  fixed  in  their  order  that  the  bee  cannot 
act  differently  without  disaster.  In  other  words,  the  bee 
has  become  a  sort  of  living  machine  to  do  a  certain  kind 
of  work ;  it  functions  without  choice,  hence  there  is  very 
little  power  of  adaptation  or  chance  for  variation.  This 
is  strikingly  proved  by  the  facts  that  the  workers  stultify 
themselves  to  feed  the  queen  and  the  drones;  that  they 
rear  hundreds  of  males  instead  of  a  dozen  or  two— ample 
for  the  function  they  are  to  perform — and  that  they  have 
repeated  the  same  actions  without  any  material  changes 
since  time  immemorial.  They  are  slaves  to  their  instincts, 
subject  to  the  food  which  a  comparatively  small  environ- 
ment provides,  and  progress  is  barred.  It  is  similar  with 
higher  animals,  although  the  instincts  are  a  little  more 
elastic,  giving  a  slightly  larger  sphere  for  choice  and 
individual  satisfaction.  With  this  greater  elasticity  of 
the  instincts  was  given  the  possibility  of  mind,  and  in 
proportion  as  we  advance  in  the  animal  scale,  mind  be- 


FACTORS  OF  HEALTH 


47 


comes  more  prominent,  until  we  come  to  man  with  his 
very  much  larger  mentality.  Just  when  and  where  this 
transition  took  place,  is  an  unsolved  problem,  and  may 
always  remain  so.  Suffice  it  to  say,  that  under  unusually 
favorable  circumstances  the  transition  was  made,  and 
mind  became  for  the  first  time  an  important  item  in  evo- 
lution. For  man,  being  equipped  with  but  few  and  com- 
paratively inefficient  natural  weapons,  had  to  depend  on 
the  development  of  his  mind  if  he  was  to  live.  This  was 
the  more  necessary,  since  the  gain  he  had  made  was 
dearly  bought — it  cost  him  the  inerrancy  of  his  instincts. 
Being  no  longer  compelled  to  react  in  certain  prescribed 
ways,  he  had  to  think,  plan,  and  scheme.  But  that  re- 
quired relatively  greater  vitality  or  a  surplus  of  energy, 
since  the  loss  of  the  inerrancy  of  his  instincts  had  de- 
prived him  of  the  more  economical  and  frictionless  ex- 
penditure of  energy.  Thinking  in  its  early  stages  in- 
volves more  or  less  useless  expenditure,  since  it  must 
proceed  by  the  wasteful  method  of  trial  and  error;  this 
is  the  case  even  today,  a  good  illustration  being  furnished 
by  a  new  medicine,  salvarsan,  also  called  "  606  "  by  its 
inventor  because  the  previous  605  experiments  had  failed 
to  yield  the  desired  results.  High  vitality  could  not  be 
developed,  however,  in  the  tropics  where  endemic  dis- 
eases were  constantly  counteracting  the  favorable  factors 
of  an  ample  food  supply  and  mild  climate.  Hence  only 
one  course  was  left  open — migration  northward  into  more 
salubrious  regions.  In  these  migrations,  only  those  who 
had  the  relatively  highest  vitality  could  engage.  They 
were,  like  the  pioneers  of  later  times,  the  strongest  and 
most  active  and  most  intelligent.  (See  chapter  on  Health 
and  the  Tropics.)  This  was  the  first  and  most  primitive 
method  of  controlling  nature — ^by  migration — a  method 
which  animals  share  in  to  a  certain  extent.    These  migra- 


II 


'  1  1  nss'! 


48        HEALTH  AND  SOCIAL  PROGRESS 

tions  opened  up  new  possibilities  to  man.  He  had  to  meet 
new  situations  in  the  way  of  enemies,  adapt  himself  to 
new  conditions  of  food,  cross  mountains  and  rivers,  and 
in  a  hundred  different  ways  develop  new  aptitudes. 
Every  successful  attempt  opened  up  new  vistas  before 
him,  and  every  new  contact  with  nature  or  other  men  sug- 
gested new  developments.  In  proportion  as  he  pro- 
ceeded into  higher  latitudes,  his  vitality  rose,  and  he  was 
thus  better  able  to  meet  the  demands  involved  in  getting 
a  living  under  the  less  prodigal  climate  of  the  temperate 
zone.  He  increased  his  control  over  nature,  and  became 
through  increasing  civilization  less  dependent  on  his  im- 
mediate environment.  The  peoples  who  were  unable  or 
unwilling  to  migrate  north,  continued  to  live,  but  were 
hardly  able  to  develop,  and  have  remained  in  a  stage  of 
savagery  or  barbarism  until  today.  And  they  are  still 
almost  entirely  dependent  on  nature  for  all  necessaries  of 

life. 

Along  with  this  control  of  nature  through  the  develop- 
ment of  the  intellect  went  a  liberation  of  himself  from 
the  thraldom  of  instincts  which  still  survive  in  him,  e.g,, 
for  food  and  sex.  These  are  practically  inerrant  in 
animals  living  in  the  state  of  nature,  and  are  thus  con- 
tributory to  individual  and  social  welfare.  When,  with 
the  origin  of  man,  mind  assumed  a  more  prominent  part 
in  evolution,  it  was  at  first  primarily  an  abundance  of 
feeling  and  imagination,  controlled  but  little  by  reasoning; 
hence  the  numerous  and  often  revolting  orgies  engaged 
in  by  savage  and  barbarous  peoples.  Occasional  abun- 
dance of  food,  due  to  success  in  war  or  in  the  chase,  al- 
ways led  to  extraordinary  exhibitions  of  excesses  in  both 
of  these  instincts,  and  were  frequently  continued  even  in 
higher  civilizations,  e.g.,  among  Phoenicians  and  in  India, 
when  the  food  supply  was  regular.    The  poor  nutrition 


FACTORS  OF  HEALTH 


49 


of  the  savage  produces  an  unstable  mentality  which  ior 
clines  to  extremes  of  excitement  and  joy,  or  of  depression 
and  melancholy.  With  an  increasingly  regular  and  bet- 
ter food  supply,  the  physical  organism  becomes  more 
stable  and  more  capable  of  self-control,  and  at  least  the 
worst  irregularities  in  the  satisfaction  of  these  instincts 
disappear.  This  statement  is  borne  out  by  the  fact  that 
modem  medicine  looks  upon  too  pronounced  irregulari- 
ties along  these  lines  as  due  to  malnutrition,  if  not  disease. 
A  brief  consideration  of  morality  will  bring  further 
corroboration  of  this  reasoning. 

As  his  intelligence  increased,  man  soon  recognized  the 
injurious  effects  of  excesses  both  upon  himself,  and  upon 
those  surrounding  him.  He  formed,  consequently,  a 
crude  code  of  ethics,  put  chiefly  in  the  form  of  prohibi- 
tions, and  enforced  conformance  to  them  by  various 
punishments.  But  there  were  always  those  who  could  not 
be  prevented  by  any  kind  of  penalty— even  the  most 
severe — from  acting  contrary  to  ethical  demands.  Were 
they  unwilling  or  unable  to  obey  ?  The  punishment  meted 
out  to  them  clearly  shows  the  attitude  of  older  civiliza- 
tions in  regarding  them  unwilling  and  therefore  responsi- 
ble; the  modern  attitude  on  the  part  of  the  enlightened 
just  as  plainly  indicates  that  their  shortcomings  are  con- 
sidered due  to  physical  defects. 

"  At  the  end  of  the  best  part  of  a  life  spent  among  prisoners, 
a  prison  surgeon  declares  himself  to  be  mainly  impressed  with 
their  extreme  deficiency  or  perversion  of  moral  feeling,  the 
strength  of  the  evil  propensities  of  their  nature,  and  their  utter 
impracticability;  neither  kindness  nor  severity  availing  to  pre- 
vent them  from  devising  and  doing  wrong  day  by  day,  although 
their  conduct  brought  upon  them  further  privations.  Their  evil 
propensities  are  veritable  instincts  of  their  defective  nature, 
acting,  like  instincts,  in  spite  of  reason,  and  producing,  when 
not  gratified,  a  restlessness  which  becomes  at  times  uncontroU- 


.% 


11 


50 


HEALTH  AND  SOCIAL  PROGRESS 


FACTORS  OF  HEALTH 


51 


able.  Hence  occur  the  so-called  'breakings  out*  of  prisoners, 
when,  without  apparent  cause,  they  fall  into  paroxysms  of 
excitement,  tear  their  clothing  and  bedding,  assault  the  officers, 
and  altogether  behave  for  a  time  like  furious  madmen."  ^^ 

The  criminal  is  not  necessarily  endowed  with  bad  quali- 
ties, but  he  lacks  the  coordinating  power  of  a  well- func- 
tioning brain.  The  defect  may  be  due  to  some  specific 
malformation,  disease,  or  to  malnutrition.  Poor  func- 
tioning in  the  case  of  the  two  former  is  so  evident  to  any 
observer,  that  it  need  not  be  discussed.  Concerning  mal- 
nutrition, a  few  words  are  needed.  The  brain  grows  at 
a  much  smaller  ratio  than  the  other  organs ;  this  seems  to 
indicate  that  the  vegetative  functions  demand  an  increas- 
ingly larger  share  of  the  nutrition  furnished.**  The 
organism  must,  first  of  all,  live;  whether  its  life  is  to  be 
well-directed  and  efficient,  is  a  secondary  consideration. 
This  is  well  illustrated  by  the  fact  that  idiots,  if  protected 
against  adversities,  may  live  to  middle  age ;  and  that  after 
the  stage  of  active  thinking  and  reasoning  is  passed  in  the 
case  of  some  old  people,  the  vegetative  functions  continue 
sometimes  for  a  number  of  years.  Hence  the  inference 
would  seem  justified,  that  the  brain  receives  only  such 
nutrition  as  is  not  absolutely  needed  for  the  maintenance 
of  life.  In  other  words,  where  general  vitality  is  low,  the 
brain  is  likely  to  suffer  first  and  most ;  and  the  cortex  is 
likely  to  suffer  most  severely,  since  both  the  sensory  and 
motor  centers  are  needed  for  the  mere  maintenance  of 
life.  The  power  of  coordination  must,  consequently,  be 
small  in  persons  of  low  vitality.  And  it  is  this  particular 
ability  which  the  immoral  classes  lack.  They  are  unable 
to  coordinate  their  actions  to  each  other,  hence  the  more 
or  less  pronounced  impulsiveness  of  their  behavior ;  they 
generally  react  on  the  stimuli  of  a  particular  organ,  rather 
than  on  the  demands  of  the  system  as  a  whole,  i.e.,  they 


are  under  the  sway  of  an  organ  which  demands  and  re- 
ceives more  attention  than  it  would  receive  in  a  well- 
balanced  healthy  organism;  e.g.,  in  the  drunkard  and 
dyspeptic,  the  stomach ;  in  the  nymphomaniac,  the  sexual 
appetite.  These  people  lack,  consequently,  the  power  of 
coordination,  and  act  in  a  self -centered  manner.  And 
from  that  condition  to  selfish  action,  there  is  only  one 
step.  In  the  case  of  those  suffering  from  malnutrition 
with  its  consequent  low  vitality,  it  is  either  a  special  organ 
that  is  at  fault,  or  a  general  lack  of  vigor  on  the  part  of 
all  organs,  making  impossible  a  proper  nourishment  of 
the  brain ;  hence  a  general  lack  of  coordination,  or  hasty 
reaction  on  some  external  stimulus,  due  to  the  small  in- 
hibitory powers  of  the  brain.  For  the  unity  of  the  organ- 
ism not  only  suggests  that  the  improper  functioning  of 
one  organ  affects  all  others,  but  also  the  special  part  of 
the  brain  with  which  it  is  in  sympathy.  "  The  internal 
organs  are  plainly  not  the  agents  of  their  special  func- 
tions only,  but,  by  reason  of  the  intimate  consent  or  sym- 
pathy of  functions,  they  are  essential  constituents  of  our 
mutual  life."  " 

Summing  up,  then,  we  may  say,  that  the  moral  element 
is  an  essential  part  of  a  complete  and  sound  character, 
and  is  based  on  a  sound  body;  it  is  the  ability  to 
coordinate  one's  actions  to  each  other,  and  to  those  of 
other  people. 

When  this  ability  is  of  a  high  order,  we  have  sociality. 
For  sociality  demands  not  only  that  the  individual  should 
correlate  his  actions  to  those  of  other  people,  but  that  he 
should  do  so  in  a  vigorous  and  efficient  manner.  Nega- 
tive morality  is  still  too  frequent,  and  is  the  only  possible 
thing  for  people  of  low  vitality,  as  was  shown  above. 
Positive  morality  or  sociality  is  possible  only  to  those  who, 
pwing;  to  large  surplus  energy,  are  able  to  coordinate  io 


% 


II 


52 


HEALTH  AND  SOCIAL  PROGRESS 


a  comprehensive  manner,  accurately  and  quickly;  and 
who  have  sufficient  energy  to  infuse  enthusiasm  into 
others,  and  make  them  cooperate.  A  moral  man  may 
suggest  new  plans  of  action;  the  social  man  alone  can 
unite  the  many  in  cooperation  by  virtue  of  his  energy, 
which  enables  him  to  plan,  scheme,  and  work  for  those 
whose  vitality  requires  them  to  confine  themselves  to  the 
most  necessary  activities.  It  is  the  vocation  of  these  men 
to  procure  more  goods  than  needed  for  immediate  con- 
sumption, to  provide  some  leisure  for  at  least  a  small  por- 
tion of  the  community,  and  eventually  for  all. 


CHAPTER  V      •  i 

HEALTH  AND  CIVILIZATION 

In  the  course  of  history,  the  problem  of  leisure  was 
solved  through  the  warriors  at  first,  or  through  the 
institutions  of  militarism  and  slavery.  It  was  a  crude 
and  barbarous  solution,  but  the  only  one  that  could  be 
resorted  to  at  that  time.  It  is  not  a  part  of  this  discus- 
sion to  show  how  slavery  produced  a  leisure  class  and 
accustomed  the  vast  majority  of  men  to  give  up  their 
wild  and  roaming  life  for  that  of  contiriuous  toil  and 
labor  under  the  lash  of  task-masters.^^  Our  only  concern 
is  the  fact  that  the  most  vigorous  men  physically  were 
the  agents  of  progress  along  this  line.  Whatever  one  may 
think  about  mere  physical  strength  in  modern  times,  it 
played  a  distinctly  beneficial  role  in  antiquity;  and  even 
Aristotle  admits  "  that  the  conqueror  is  always  superior 
in  respect  of  some  good  or  other;  hence  it  appears  as 
though  force  were  never  dissociated  from  virtue."  "  It 
is,  of  course,  not  to  be  expected  that  the  savage  who  was 
physically  strong,  would  work  for  others,  since  he  was 
not  sufficiently  advanced  in  morality  and  sociality  to  do 
that.  He  made  others  work,  and  profited  by  their  labor. 
This  gave  him  some  leisure.  In  many  cases  this  was  ill 
used;  in  a  few,  well  used.  The  chief  results  were  an 
increase  in  the  number  of  the  leisure  class  and  a  conse- 
quent division  of  mental  work  among  its  two  principal 
sections — the  warriors  and  the  thinkers. 
The  warriors,  generally  the  physically  strongest  and 

mpst  ^ptive,  devpted  themselves  not  tp  war  only,  but  tp 


54        HEALTH  AND  SOCIAL  PROGRESS 

the  development  of  industry  and  politics.  They  wanted 
military  pomp  and  splendor,  rich  feasts  and  large  estab- 
lishments ;  in  order  to  procure  them,  they  had  to  develop 
whatever  industrial  resources  were  at  their  command,  or 
call  them  into  existence.  King  Solomon  is  a  good  illus- 
tration of  this  class,  with  the  building  of  the  temple  and 
palaces  at  Jerusalem  and  summer  cottages  in  the  country. 
This  industrial  expansion  necessitated  political  alliances, 
and  so  he  formed  a  treaty  with  King  Hiram,  and  estab- 
lished friendly  relations  with  the  kings  of  Egypt,  Arabia, 
and  other  rulers  to  procure  the  products  of  their  countries 
and  protect  his  fleets  and  caravans.  He  is  one  of  the 
few  kings  noted  for  his  wisdom — if  that  is  not  merely 
attributed  to  him  by  the  historians  and  courtiers  who 
credited  him  with  other  men's  wise  achievements;  for 
apart  from  the  seventy-second  psalm  which  bears  his 
name,  we  have  nothing  direct  from  his  pen;  and  the 
authorship  of  that  is  denied  him  by  Biblical  scholars. 

The  chief  work  in  mental  development  devolved,  how- 
ever, upon  the  priests  and  upon  the  scholars — the  latter 
being  for  a  long  time  associated  with  religious  institutions 
and  having  gained  their  independence  only  lately  and  only 
in  the  most  civilized  countries.  These  men  made  the 
art,  poetry,  philosophy,  and  science  of  those  times.  They 
were  always  a  leisure  class  and  in  comparatively  affluent 
circumstances,  but  rarely  as  strong  and  vigorous  as  the 
warriors.  According  to  Professor  Giddings,  the  scholars 
have  as  a  rule  medium  vitality,  while  the  warriors  gener- 
ally belong  to  the  high  vitality  class."  The  vast  majority 
of  the  people,  being  slaves  and  toilers,  poorly  fed  and 
housed,  had  low  vitality.  This  fact  explains  such  vic- 
tories as  those  at  Marathon,  where  a  handful  of  intelli- 
gent and  vigorous  Greeks  defeated  a  large  army  of  igno- 
rant slaves  with  low  vitality,  since  one  hundred  slaves^ 


HEALTH  AND  CIVILIZATION 


SS 


with  systems  habitually  on  the  defensive  and  without 
energy  to  strike  a  vigorous  blow,  were  no  match  for 
even  one  Greek.  The  health  and  intelligence  of  the  latter 
created  confidence  and  a  circumspect .  attitude,  the  low 
vitality  of  the  former  a  craven  spirit  which  was  ready 
to  yield  at  the  first  onslaught. 

This  division  of  mental  work  produced  other  results. 
With  the  low  vitality  of  primitive  groups  due  to  poor 
food,  there  could  be  no  great  enterprise.  They  merely 
wandered  about  to  find  food  and  avoid,  as  far  as  possible, 
encounters  with  other  groups.  When,  owing  to  slavery, 
the  warriors  were  better  fed,  their  enterprise  increased; 
they  began  tp  love  exploits  and  battles;  they  deliberately 
set  out  on  far  journeys  into  unknown  regions,  because 
their  surplus  energy  gave  them  confidence  and  self-re- 
liance in  any  circumstances.  These  war-like  expeditions, 
whether  t^  ey  resulted  in  permanent  settlements  or  were 
only  of  a  temporary  nature,  became  the  means  of  mixing 
and  amalgamating  various  peoples.  It  gave  the  kings 
and  leaders  larger  visions,  and  the  conception  of  world- 
empires  arose  in  the  minds  of  the  boldest.  Very  nearly 
every  one  of  the  conquerors  of  antiquity  had  the  ambition 
to  include  all  peoples  under  his  sway.  The  numerous 
failures  at  last  suggested  the  idea  of  international  law, 
the  jus  gentium  of  the  Romans,  and,  consequently,  that 
empire  enjoyed  a  greater  stability  than  any  of  its  prede- 
cessors. This  law  was  the  direct  result  of  conquests 
and  of  the  endeavor  to  retain  the  fruits  of  victory  as  far 
as  land  and  other  possessions  were  concerned.  A  more 
important,  because  more  permanent,  result  was  the  mix- 
ing of  peoples  which  took  place  in  the  Roman  empire. 
In  this  process  of  assimilation  various  new  traits  were 
formed,  most  of  which  were  good  when  not  too  divergent 
types  mingled — ^as  was  the  case  until  approximately  the 


IT 


I 


56        HEALTH  AND  SOCIAL  PROGRESS 

beginning  of  the  Christian  era ;  later,  when  types  of  all 
kinds  mixed,  they  were  socially  bad,  because  the  lower 
people  infused  their  low  vitality  into  the  already  depleted 
stock  of  the  Romans,  who  had  lost  their  ablest  men  on 
various  battlefields.  This  has  been  the  case  with  every 
nation  that  has  engaged  in  too  protracted  warfare.  On 
the  whole,  the  eflfects  of  mixture  were,  however,  good, 
since  more  vigorous  races  resulted,  and  the  mind  of  man 
was  tremendously  stimulated.  It  was  through  this  pro- 
cess that  means  were  eventually  found  for  liberating  a 
larger  number  of  people  from  the  hardships  of  manual 
toil.    This  was  through  the  invention  of  machinery. 

Modern  industry  is  possible  only  through  the  inven- 
tion of  machinery,  and  this  was  dependent  upon  the 
leisure  of  the  few  procured  through  slavery.  It  is  not 
necessary  to  go  into  any  details  about  the  successive  and 
wonderful  inventions  and  discoveries  in  science  and  in- 
dustry ;  suffice  it  to  say  that  whatever  objections  may  be 
raised  against  machinery,  it  has  procured  comparative 
leisure  for  a  much  larger  number  of  the  population,  has 
been  the  means  of  improving  health,  and  has  thus  made 
civilization  possible  on  a  much  wider  scale.  For  civ- 
ilization has  always  been  threatened  chiefly  by  poor 
health. 

What,  then,  is  civilization?  Civilization  means  the 
translation  of  the  subjective  good  into  the  objective  good  ; 
or,  to  be  more  exact,  it  is  the  process  of  transforming  the 
subjective  conception  of  the  good  into  objective  practical 
good.  This  means  simply  that  civilization  is  the  attempt 
to  ameliorate  hardships,  improve  conditions,  and  eventu- 
ally eliminate  the  worst  evils,  so  that  every  man  may 
live  a  life  worthy  of  a  human  being.  Or,  to  use  Pro- 
fessor Patten's  phrase :  "  It  is  the  transition  from  a  pain 
economy  to  a  pleasure  economy." 


HEALTH  AND  CIVILIZATION 


57 


Two  things  only  need  special  notice  in  this  definition : 
the  conception  of  the  good,  and  its  translation  into  objec- 
tive good.  The  first  depends  largely  on  the  mental  state 
of  the  individual.  If  he  is  ill,  or  at  least  in  poor  health, 
relief  will  seem  the  greatest,  if  not  the  only,  boon  to 
him,  and  he  will  conceive  civilization  as  a  process  of 
relief  or  redemption  from  evil.  Again,  if  his  mentality  is 
narrow,  he  will  conceive  it  as  applicable  only  to  his  clan, 
tribe,  or  nation.  Finally,  if  his  mind  is  of  a  low  type, 
civilization  will  mean  to  him  only  creature  comforts.  The 
second  item,  i.e.,  the  translation  of  whatever  conception 
of  civilization  one  may  have  into  objective  good,  is 
primarily  a  matter  of  economic  and  industrial  conditions, 
based  on  science.  A  few  words  concerning  these  points 
may  be  appropriate  here. 

There  could  be  no  true  civilization  in  the  past,  since 
at  best  only  a  few  of  these  conditions  existed  in  any 
nation.  As  has  been  mentioned  before,  the  history  of 
the  past  has  been  largely  dominated  by  the  conception  of 
relief  or  redemption  from  evil,  because  the  health  of  the 
people  was  generally  poor,  and  they  lacked  therefore  a 
sense  of  confidence  and  self-reliance.  Civilization  was 
conceived  in  negative  terms.  This  is  evident  when  we 
look  at  the  Hebrew  and  older  Christian  ideals.  The 
Jewish  theocracy  pictured  the  Hebrews  as  utterly  de- 
pendent on  Jehovah;  hence  any  misfortune  coming  to 
them  was  attributed  to  Him  as  a  punishment  for  their 
sins,  while  any  good  fortune  was  looked  upon  as  a 
reward  for  obedience  to  His  laws.  The  two  dominant 
notes  of  the  Old  Testament  are,  consequently,  a  sense  of 
sin  and  one  of  gratitude.  "Hear  the  prayers  of  Thy 
people,  O  Lord !  and  when  Thou  hearest,  forgive."  "  Oh, 
give  thanks  unto  the  Lord,  for  His  mercy  endureth  for- 
ever ! "    The  Christian  ideal  has  been  dominated  in  the 


w 


58        HEALTH  AND  SOCIAL  PROGRESS 

past  chiefly  by  the  spirit  of  the  Litany :  "  Good  Lord, 
deliver  us ! " 

The  religion  of  the  Greeks  was  the  only  one  which  was 
comparatively  free  from  this  negative  conception.    They 
had  many  gods,  and  if  one  or  two  of  them  were  hostile, 
others  would  be  friendly.    None  had  the  monopoly,  and 
if  any  serious  difficulty  arose  about  Achilles  or  Odysseus, 
the  matter  had  to  come  before  the  council  of  gods.    It  is 
true,  these  deities  were  not  models  of  purity  and  holi- 
ness, and  were  protie  to  pursue  the  lives  of  gentlemanly 
loafers,  but  they  were  at  least  whole  and  healthy,  and 
represented  to  the  Greeks  beings  of  fairly  unified  char- 
acters.   They  were  full  of  the  joy  of  life,  and  gave  men 
the  means  of  enjoyment  through  arts  and  sciences.    May 
this  not  be  the  reason  for  the  positive  development  of 
Greek  culture  ?    A  healthy  and,  therefore,  active  race  con- 
ceived civilization  not  merely  as  relief  from  evils,  but  as 
a  positive  joy,  full  of  achievement  and  daring  action,  as 
the  myths  of  Hercules  and  Prometheus  amply  prove. 
That  health  was  the  predominant  cause  in  this  blossom- 
ing of  art  and  science  may  be  shown  by  a  reference  to 
the  later  Greeks.  With  the  introduction  of  malaria,  health 
began  to  decline ;  productiveness  ceased,  and  the  character 
of  their  deities  changed  almost  at  once.    The  Greek  no 
longer  looked  to  Olympus  and  its  gods  endowed  with 
perpetual  youth,  and  no  longer  hoped  for  his  own  pos- 
sible endowment  with  that  quality  as  a  demi-god;  he 
exchanged  the  mountain  of  the  gods  for  implacable  Fate, 
and  the  joyous  wholeness  and  unity  of  the  human  being 
for  the  dualism  of  Plato's  "  spirit  and  matter." 

This  conception  of  Plato  was  introduced  into  Christi- 
anity, and,  after  being  assimilated  with  the  Hebrew 
sense  of  sin,  has  dominated  western  civilization  until  now. 
It  is  from  this  negative  ideal  that  strong  and  hcallhy  men 


HEALTH  AND  CIVILIZATION 


59 


are  turning  away  at  present;  the  reason  of  their  indif- 
ference to  the  churches  is  not  antipathy  to  the  moral  and 
spiritual  teachings  of  Christianity,  but  rather  apathy  to 
a  life  of  comparative  inaction.  For  the  man  who  is 
accustomed  to  depend  on  himself  and  to  cultivate  self- 
reliance  for  six  days  of  the  week  in  nearly  every  sphere 
of  his  life,  finds  it  irksome  on  the  seventh  day  to  submit 
meekly  without  the  right  of  cross-questioning,  to  the  teach- 
ing of  another.  He  finds,  moreover,  that  the  sciences,  and 
medicine  in  particular,  are  working  for  a  positive  civiliza- 
tion, containing  joy  and  happiness — a  condition  of 
things  which  will  enable  him  to  realize  that  he  is  not  here 
merely  to  prepare  for  a  future  existence,  but  that  this 
life  is  worth  living  for  its  own  sake  and  ought  to  be 
improved  as  far  as  possible  for  everyone,  instead  of  being 
made  merely  endurable.  To  this  end  he  endeavors  to 
introduce  prophylactic  measures  into  every  department 
of  life ;  to  improve  conditions  in  accordance  with  an  ideal 
to  be  attained  in  the  future  and  not  with  that  of  some 
"  golden  age,"  irrevocably  lost  in  the  distant  past ;  to  do 
and  to  achieve  something  that  is  worth  while — not  be- 
cause he  is  bidden  to  do  so,  but  because  action  of  a  whole- 
some social  nature  is  what  he  craves  and  best  expresses 
his  desire  for  an  expansion  of  life. 

The  narrowness  of  mental  ideals  has  played  a  large 
role  in  the  past.  Whatever  the  best  thinkers  of  any 
people  pictured  as  a  desideratum  in  national  ideals,  was 
always  reserved  for  their  own  people,  and  others  were 
excluded,  unless  it  was  for  the  purpose  of  serving  their 
masters.  "  It  is  meet  that  Greeks  rule  over  barbarians," 
are  the  words  of  Aristotle.  Other  nations  were  more 
narrow  even  than  the  Greeks.  Such  a  conception  of 
civilization  was,  however,  not  only  narrow,  but  moribund, 
because  no  country  is  sufficiently  equipped  with  all  the 


60        HEALTH  AND  SOCIAL  PROGRESS 

necessaries  or  comforts  of  life,  or  a  full  equipment  of 
mental  resources,  to  enable  at  least  the  majority  of  its 
inhabitants  to  develop  their  faculties.  Hence,  intercourse 
with  other  nations  is  imperatively  necessary;  it  is,  how- 
ever, impossible  without  the  recognition  of  other  people's 
rights,  and  a  narrow  national  ideal  always  implies  a 
denial  of  those  rights.  But  people  whose  economic  and 
emotional  resources  are  small  owing  to  poor  health,  are 
apt  to  be  narrow  in  their  political  conceptions.  We  thus 
come  back  to  the  question  of  health  from  another  point 
of  view. 

Finally,  if  a  man's  mind  is  of  a  low  type,  civilization  will 
mean  primarily  creature  comforts.  We  have  seen  that  a 
sickly  or  an  undervitalized  man  cannot  produce  an  active 
and  vigorous  brain,  that  he  is  self-centered  and  must 
confine  himself  to  the  most  necessary  activities.  This 
means  that  such  a  person  must  of  necessity  seek  creature 
comforts;  owing  to  his  inability  to  gain  pleasure  from 
vigorous  and  wholesome  action,  he  must  seek  relief  from 
his  pains,  or  at  least  discomforts.  For  instance,  lacking 
the  good  appetite  of  a  healthy  man,  he  must  seek,  if  not 
delicacies,  at  least  more  choice  and  better  prepared  food. 
In  regard  to  clothing,  he  must  be  more  warmly  dressed 
in  winter,  and  must  expose  himself  less  to  the  inclemen- 
cies of  the  weather,  than  the  well  man.  All  this  leads  in- 
evitably toward  a  self-centered  disposition  and  the  seek- 
ing of  comforts.  It  is  true  that  we  read  occasionally  of 
persons  who  even  during  illness  do  not  forget  the  rights 
of  others  and  are  considerate  of  others'  comfort.  This 
is,  however,  always  looked  upon  as  an  extraordinary 
exhibition  of  fortitude,  due  to  an  exceptionally  well- 
trained  will,  or  to  social  conventions.  Just  as  the  Indian 
under  torture  does  not  cry  out  owing  to  his  training,  so 
the  sick  lady  or  gentleman  will  be  most  anxious  to  avoid 


HEALTH  AND  CIVILIZATION 


61 


laying  any  extra  work  on  the  nurse.  We  are  neverthe- 
less certain  that  they  suffer,  and  we  double  our  attention 
to  spare  them  any  pains  and  tactfully  avoid  even  the  sem- 
blance of  making  efforts  for  their  comfort.  The  very 
fact  that  we  praise  such  persons  for  their  restraint  and 
fortitude  proves  that  the  normal  thing  under  suflFering  is 
the  seeking  of  relief  and  comfort  through  others,  and 
that  a  self-centered  mental  attitude  is  unavoidable.  The 
headaches,  the  nervous  irritability  of  those  in  poor  health 
are  all  continuous  witnesses  of  this  self-centered  attitude. 
The  pioneers,  whether  as  scientists  or  missionaries  or  as 
pathfinders  in  new  countries,  prove  this  contention  from 
a  different  point  of  view.  They  are  usually  men  in  good 
health,  and  seek,  either  through  love  of  truth  or  of  their 
fellowmen,  or  out  of  sheer  abundance  of  vitality,  to  in- 
crease the  world's  useful  knowledge  and  good  will,  and 
are  rarely  self -centered  as  far  as  their  attitude  is  con- 
cerned. They  act  on  the  maxim,  "  It  is  more  blessed  to 
give  than  to  receive,"  not  because  they  are  bidden,  but 
owing  to  an  inherent  need  and  desire  to  express  them- 
selves in  socially  useful  action.  A  well  man  does  not  call 
on  others  for  services;  he  considers  it  a  glory  to  be  in- 
dependent and  a  privilege  to  help  others.  The  conception 
of  what  good  means,  is  thus  necessarily  dependent  on 
one's  health. 

In  regard  to  the  second  point,  the  translation  of  this 
good  into  practical,  objective  good, — a  few  words  will 
have  to  be  said.  This  depends,  as  was  said  above,  on 
science  as  the  basis  of  a  higher  industrial  and  economic 
system.  The  philosopher  and  the  poet  may  tell  us  in 
glowing  pictures  what  they  conceive  to  be  a  social  ideal 
of  beauty  and  of  perfection  along  every  line,  and  they 
may  stir  our  imagination  with  a  desire  to  realize  it ;  but 
it  is  the  scientist  who  makes  possible  its  translation  into 


L%V 


■ 


62         HEALTH  AND  SOCIAL  PROGRESS 

objective  reality.    He  needs,  however,  good  health,  since 
his  senses  must  be  keen  and  he  must  have  a  fine  sense 
of  balance  and  coordination.    He  cannot  shape  his  system 
according  to  a  priori  principles  and  proceed  to  erect  a 
structure  of  logic  and  plausibility  upon  it;  he  has  to 
"check  up"  his  ideas  constantly  by  reference  to  new 
facts,  and  keep  his  mind  open  for  other  facts  still  to  be 
discovered.    His  attitude  has  to  be  that  of  open-minded- 
ness,  patience,  ability  to  balance,  willingness  to  change 
his  conclusions  and  to  retrace  his  steps.    All  these  quali- 
ties demand  good  health.    The  irritable  and  "  inspired  " 
poet  may,  with  a  few  strokes  of  his  pen,  give  us  a  most 
entrancing  ideal  of  what  the  future  will  bring  forth  in 
the  way  of  beauty,  truth,  and  goodness— the  scientist 
alone,  with  his  ability  to  stand  shocks  and  disappoint- 
ments, to  begin  all  over  again,  and  to  labor  for  years  at 
a  single  small  problem,  is  able  to  help  us  realize  them, 
because  he  helps  furnish  the  material  basis  for  all  cultural 
accomplishment  and  civilizational   achievements.     That 
such  careful,  patient,  and  often  tedious  work  demands 
not  only  a  fine  nervous  system  but  general  fair  health, 
will  be  discussed  more  fully  in  the  chapter  on  Health 
and  Originality. 

This  attitude  of  the  healthy  man  toward  objective 
social  action  indicates  the  transition  from  a  pain  economy 
to  a  pleasure  economy.  Nature  demands  the  satisfaction 
of  certain  physical  wants,  because  these  are  necessary  for 
the  fulfillment  of  the  functions  of  life.  It  is  true  that  this 
furnishes  a  certain  amount  of  physical  pleasure,  but  it 
is  very  elementary  and  is  more  on  the  level  of  the  animal 
than  of  man.  When,  for  instance,  the  savage— half 
starved  and  more  or  less  exhausted— succeeds  in  getting 
an  ample  food  supply  by  killing  a  deer,  he  does  not  ob- 
serve any  niceties  about  eating,  but  swallows  the  meat 


HEALTH  AND  CIVILIZATION 


63 


half  raw  and  without  much  attention  as  to  mastication. 
Nature  imperatively  demands  food,  and  the  savage  meets 
that  demand  and  so  fulfills  a  natural  function.      The 
pleasure  is  rudimentary  and  animal,  just  as  in  the  case 
of  a  hungry  dog.    Compare  with  that  eating  the  feasting 
of  a  modem  man— the  elaborate  preparations,  the  clean 
table  linen,  the  attractive  china,  the  flowers,  the  cheerful 
company,  perhaps  music,  the  dishes  gathered  from  almost 
every  comer  of  the  globe — and  you  have  a  natural  func- 
tion satisfied  plus  a  purely  human  pleasure,  because  the 
physical  has  been  raised  through  the  accompanying  men- 
tal satisfaction  to  a  higher  level  which  the  animal  can 
never  attain.    It  is  the  same  way  with  other  things.    Most 
men  need   shelter  and  clothing   for  protection  against 
inclemencies  of  weather ;  but  what  a  difference  between 
the  cave  or  the  rude  hut  of  the  savage  and  the  mansion 
of  civilized  man,  or  between  the  dried  and  hard  skin  of 
animals  used  by  the  barbarian,  and  the  artistic  clothing 
of  a  woman  of  fashion  serving  the  purpose  of  protec- 
tion much  more   successfully   while  at  the   same  time 
satisfying  an  aesthetic  demand.    The  savage  may  dream 
about  feasting  and  whatever  he  considers  fine  clothing  or 
a  pretentious  abode,  but  he  is  bound  down  to  fulfilling 
nature's  demands  in  the  most  primitive  manner.     It  is 
civilization  that  has  enabled  mankind  to  advance  from 
that  stage  of  a  pain  economy  to  one  of  pleasure.    And 
civilization  is  the  result  of  health. 

We  saw  above  that  a  man  of  low  vitality  can  do  but 
little  more  than  take  care  of  himself,  i.e.,  provide  for 
his  most  elementary  needs,  because  there  is  no  energy 
left  for  any  attempt  to  improve  his  condition  by  planning, 
or  experimentation.  It  was  the  leisure  class,  the  vigorous, 
well-nourished  individuals  who  had  enough  energy  left 
after  their  daily  work  to  scheme,  plan,  and  experiment  in 


^ 


i  ] 


'■;  j 


64 


HEALTH  AND  SOCIAL  PROGRESS 


order  to  husband  and  increase  nature's  provisions  and  to 
raise  life  to  a  higher  level  through  the  development  of 
art,  science,  and  philosophy  that  produced  civilization. 
The  sick  man  even  today  is  largely  in  the  position  of 
the  savage;  he  eats,  because  he  has  to  and  takes  no 
pleasure  in  meeting  nature's  demand.  And  he  cannot 
contribute  anything  toward  improving  either  his  own  or 
other  people's  condition ;  he  consumes  but  does  not  pro- 
duce. Where  there  is,  however,  a  large  number  of 
people  who  consume  without  producing,  civilization  is 
impossible ;  and  where  only  little  more  is  produced  than 
necessary,  it  is  in  a  precarious  condition;  because  the 
translation  of  the  conception  of  the  subjective  good  into 
objective  good  means  in  terms  of  economics  a  greater 
production  than  is  necessary  for  immediate  wants,  and 
thus  the  procuring  of  leisure  or  exemption  from  too  ex- 
hausting toil.  It  is  plain  that  the  sick  man  cannot  do 
that,  and  it  takes  but  little  reasoning  to  see  that  the 
undervitalized  man  cannot  do  it  either.  The  latter  works 
uneconomically,  because  he  has  to  force  himself,  and  is 
thus  soon  exhausted,  and  mighty  glad  to  stop  when  his 
immediate  wants  are  met.  The  advance  of  civilization  is, 
thus,  always  dependent  on  the  health  of  the  people. 

This  may  be  illustrated  by  a  few  references  to  nature- 
peoples.  They  are  seldom  regularly  and  sufficiently  fed ; 
it  is  usually  a  case  of  starvation  or  of  over-indulgence 
when  plenty  is  to  be  had;  the  Igorots  of  the  Island  of 
Luzon  consider  it  bad  manners  to  leave  any  eatables  for 
tomorrow.  Under  these  circumstances  no  higher  or  even 
medium  vitality  can  be  developed,  and  consequently  no 
surplus  energy  for  an  advance  socially  or  mentally.  En- 
demic diseases  are  another  cause  of  keeping  vitality  down 
to  its  lowest  level,  and  nature-peoples  are,  as  a  result, 
condemned  to  a  pain  economy.    Being  constantly  faced 


HEALTH  AND  CIVILIZATION 


68 


with  starvation,  and  therefore  always  more  or  less  surly 
and  morose  owing  to  poor  health,  it  is  small  wonder  that 
many  nature-peoples  have  invented  barbarous  methods 
of  getting  rid  of  the  aged  or  of  superfluous  children. 
Their  morals  are  merely  a  result  of  their  poor  health. 
A  hungry  man  knows  no  mercy,  and  a  sick  one  no  com- 
passion. Whatever  of  song  and  of  poetry,  art  and  social- 
ity existed  among  nature-peoples,  was  produced  at  the 
rare  times  of  plenty  when  men  were  happy  because  the 
craving  for  food  had  been  satisfied  and  when,  conse- 
quently, a  slight  excess  of  energy  had  been  produced. 
No  people  has  ever  succeeded  in  rising  above  the  level  of 
savages  unless  it  possessed  at  least  fair  health;  where 
either  economic  or  climatic  conditions  prevented  health, 
no  civilization  could  arise;  and  where  it  had  arisen  it  was 
doomed  whenever  new  conditions  arose  which  under- 
mined health. 

Health  is,  thus,  the  principal  index  to  civilization,  be- 
cause it  shows  control  over  nature  by  society  as  a  whole, 
and  ability  on  the  part  of  the  individual  to  utilize  these 
means  of  control  for  his  own  benefit.  This  control  im- 
plies the  ability  to  secure  a  suitable  supply  of  food  as 
regards  quantity  and  quality,  to  counteract  or  avoid  the 
effects  of  endemic  diseases,  and  thus  to  lay  up  a  store  of 
surplus  energy. 

This  control  of  nature  demands  work,  i.e.,  the  per- 
sistent and  intelligent  application  of  physical  and  mental 
energy  toward  a  clearly  conceived  social  end.  Where 
human  energy  is  not  applied  persistently  but  by  "  fits 
and  starts,"  we  have  the  wasteful  expenditure  of  the 
savage  who  will  dance  for  two  or  three  days  with  but 
few  intermissions  until  the  point  of  utter  exhaustion  is 
reached.  If  he  is  not  engaged  in  warfare  at  the  time, 
well  and  good ;  he  can  sleep  and  rest  for  a  week  or  two. 


66         HEALTH  AND  SOCIAL  PROGRESS 

until  restored  to  his  normal  condition.    If  he  has  enemies, 
they  will  watch  for  just  such  an  opportunity  and  over- 
come him  easily.    It  seems  to  me  that  this  is  the  explana- 
tion of  the  numerous  cases  where  often  a  handful  of 
men  defeated  a  large  army,  generally  after  a  period  of 
orgies  and  carousals  when  energy  had  been  fully  ex- 
hausted, so  that  new  emergencies  could  not  be  met.    Such 
orgies  preceding  an  attack  are  directly  mentioned  as  a 
cause  of  defeat  in  a,  number  of  cases,  e.g.,  Belshazzar's 
fall,  and  the  victory  of  Frederick  the  Great  at  Rossbach. 
Where  the  application  of  energy  is  not  intelligent,  we 
have  mere  toil  which  exhausts  but  produces  very  small 
returns ;  slave  labor  and  so-called  "  unskilled  "  labor  is 
of  that  nature.     It  gives  very  little  mental  satisfaction. 
Where,  finally,  the  end  is  not  clearly  conceived  as  social, 
we  have  either  misdirected  energy,  as  in  the  case  of 
the  older  Japanese  craftsmen  who  wasted  several  years 
on  the  production  of  an  intricate  toy,  or  the  well-directed 
energy  of  the  selfish  exploiter  who  seeks  satisfaction  in 
domination    over    others.      Another    case    is    possible, 
namely,  that  of  the  pleasure  seeker  in  abnormal  excite- 
ment.   A  few  words  concerning  each  of  these  cases  will 
be  necessary. 

The  persistent  application  of  energy  requires  a  good 
stock  of  vitality,  since  it  is  the  continuous  although  less 
strenuous  application  that  is  tiring.  Even  such  easy  work 
as  bookkeeping  demands  more  energy  than  the  average 
savage  possesses.  Such  well-distributed  expenditure  over 
a  long  period  of  time  requires  an  excellent  control  over 
one's  whole  body,  and  that  is  possible  only  with  good 
vitality.  The  savage  neither  has  the  vitality  owing  to 
undernutrition  or  malnutrition,  nor  has  he  a  sufficient 
control  over  his  body,  owing  to  his  poorly  constructed 
nervous  system.     Hence  savages,  barbarians,  and  even 


HEALTH  AND  CIVILIZATION 


67 


semi-civilized  peoples  have  never  been  able  to  work,  and 
wherever  they  were  forced  to  do  so  by  stronger  men,  they 
succumbed  in  a  short  time.  This  is  the  primary  reason 
for  the  rapid  disappearance  of  nature-peoples  when  com- 
ing in  contact  with  civilization,  since,  being  deprived 
of  their  former  means  and  methods  of  living  through  the 
chase,  and  unable  to  create  a  sufficient  amount  of  energy 
suddenly,  they  were  imable  to  adapt  themselves  to  new 
conditions  and  rapidly  fell  victims  to  exhaustion  or 
diseases.  Volumes  have  been  written  by  well-meaning 
persons  on  the  deliberate  cruelty  of  civilized  nations  in 
killing  off  those  on  lower  levels  of  civilization.  The  proc- 
ess of  extinction  is,  however,  inevitable,  unless  nature- 
peoples  succeed  in  creating  a  larger  amount  of  vitality 
which  will  fit  them  for  work.  It  is  not  the  gun  of  the 
white  man  which  has  exterminated  the  red  and  many 
of  the  brown  races,  but  their  inability  to  work,  as  may 
be  seen  by  a  comparison  with  the  Mongols  who,  although 
not  particularly  well  fed,  have  long  ago  acquired  the 
habit  of  work,  and  are  now  becoming  the  competitors  of 
the  white  man — successfully,  too,  wherever  they  are  able 
to  get  better  food  owing  to  higher  wages. 

The  unintelligent  application  of  mere  physical  energy 
is  toil,  and  gives  but  little  satisfaction  to  a  human  being, 
besides  being  unremunerative.  We  find,  therefore,  that 
countries  like  the  Balkans  and  Russia  in  Europe,  and 
large  parts  of  China  do  not  produce  any  high  type  of 
men  among  their  peasantry ;  because  there  is  no  satisfac- 
tion in  merely  meeting  the  demands  of  nature  to  live.  A 
man  must  have  something  more  than  mere  animal 
pleasures  if  he  is  to  rise  to  a  higher  level  of  civilization ; 
he  must  take  pleasure  in  his  work,  and  express  himself 
through  it.  That  cannot  be  done  through  mere  toil; 
hence  the  absence  of  inventions  fpr  the  amelioration  of 


68 


HEALTH  AND  SOCIAL  PROGRESS 


economic  conditions  and  the  proverbial  poverty  of  those 
countries.  In  England,  Germany,  France,  America,  and 
in  Australia,  men  enjoy  their  work  because  there  is  a  keen 
pleasure  in  mastering  an  intricate  problem  which  taxes 
one's  ingenuity;  these  countries  have  succeeded  in  re- 
lieving their  people  from  mere  toil  by  having  it  per- 
formed through  machinery.  True,  there  is  a  new  danger 
lurking  here,  since  many  working  men  have  become  an- 
nexes to  the  machines  which  they  attend.  The  remedy 
has,  however,  already  been  found  in  shorter  hours  and 
more  varied  means  of  enjoying  leisure,  both  made  pos- 
sible by  the  greater  production  of  machinofacture  over 
manufacture.  The  man  who  works  only  with  his  hands, 
rarely  produces  more  than  he  needs;  it  is  the  machine 
which  helps  us  to  produce  a  surplus,  and  thus  to  create 
leisure.  We  are  already  meeting  this  problem  of  the 
possible  deterioration  of  our  working  classes  through  the 
monotony  of  their  employment  by  encouraging  them  to 
follow  an  avocation  during  their  leisure  hours,  and  thus 
developing  those  qualities  which  are  not  exercised  in 
their  occupation.  Ideally,  vocation  and  avocation  should 
coincide,  and  man  should  find  his  greatest  satisfaction  in 
his  work,  and  his  keenest  joy  in  making  it  more  effective 
for  himself  and  others.  As  yet,  we  are  far  from  that 
goal ;  but  we  have  at  least  come  to  recognize  it  as  attain- 
able. 

The  more  or  less  useless  work  of  the  Japanese  crafts- 
man is  a  thing  of  the  past  even  in  his  own  country,  and  it 
has  rarely  existed  in  modern  Europe  or  in  America.  We 
are,  however,  threatened  with  a  similarly  useless,  if  not 
unsocial,  form  of  expending  energy.  Many  women  and 
some  men  among  our  rich  people  are  seeking  pleasure  in 
more  or  less  abnormal  excitement,  and  some  men  and 
women  among  the  poorer  classes  imitate  them.    That 


HEALTH  AND  CIVILIZATION 


69 


such  expenditure  is  harmful,  is  obvious ;  that  it  is  based 
on  an  insufficient  state  of  health,  is  more  difficult  to 
prove.    The  attempt  will,  nevertheless,  be  made. 

In  introducing  the  subject  of  health  above,  it  was  stated 
that  the  human  body  is  a  machine  for  action  in  order  to 
preserve  and  improve  life,  and  that  the  mind  is  the  guide 
of  actions  along  those  lines.     Hence,  "as  a  matter  of 
necessity,  man  is  an  agent.    He  is,  in  his  own  apprehen- 
sion, a  creature  of  unfolding  impulsive  activity — *  tele- 
ological  *  activity.    He  is  an  agent  seeking  in  every  act  the 
accomplishment  of  some  concrete,  objective,  impersonal 
end.    By  force  of  being  such  an  agent  he  is  possessed  of 
a  taste  for  effective  work,  and  a  distaste  for  futile  efforts. 
He  has  a  sense  of  the  merit  of  serviceability  of  efficacy 
and  of  the  demerit  of  futility,  waste,  or  incapacity.    This 
aptitude  or  propensity  may  be  called  the  instinct  of  work- 
manship." "    Wherever  man  violates  this  law  of  effective 
and  useful  action,  and  wastes  his  energies  in  futile  effort 
his  faculties  will  decline  in  power  and  the  wrongfully 
used  organs  will  deteriorate.    And  that  is  exactly  what 
has  happened  to  our  American  "  idle  "  class,  more  par- 
ticularly to  the  newly  and  ultra  rich  women.     They  are 
supplied  by  their  husbands  with  everything  that  money 
can  provide;  they  have  no  responsibility,  no  inducement 
for  useful  effort  of  any  kind,  and  nothing  to  occupy  their 
ample  leisure  except  amusement.    Is  it  any  wonder  that 
their  nervous  systems  deteriorate,  and  that   more  ex- 
citing pleasures  are  being  sought  by  them  so  as  to  re- 
move that  sense  of   tccdium  vitco  and  of  vacuity  with 
which  they  are  oppressed?     Having   refused   in  many 
cases  to  become  mothers  in  order  not  to  interfere  with 
their  bridge  and  opera  parties,  they  have  at  last  become 
unable  to  bear  children,  as  Mrs.  Olive  Schreiner  so  ably 
argues  in  her  Woman  and  Labor,     The  result  is  an 


70        HEALTH  AND  SOCIAL  PROGRESS 

increased  nervousness  and  restlessness,  since  no  one  can 
violate  nature's  laws  with  impunity,  and  the  sense  of 
having  failed  to  fulfill  any  mission  in  life  leads  to  still 
further  cravings  for  excitements  which  violate  the  ordi- 
nary social  laws.  Hence  an  increasing  number  of  in- 
discretions and  scandals  as  reported  by  the  daily  press. 

At  the  other  end  of  the  social  scale  we  have  a  similar 
nervousness  for  different  reasons.  Working  girls  get 
over-fatigued,  and  instead  of  seeking  rest  for  their  aching 
nerves,  they  attempt  to  drown  their  weariness  in  amuse- 
ments for  which  they  are  unable  to  pay.  The  result  is 
increased  excitability,  depression,  and  eventually  d^ener- 
ation.  The  only  desire  which  these  women — ^both  rich 
and  poor — ^have,  is  to  out-do  somebody  else  in  extrava- 
gance, no  matter  what  the  cost.  They  must,  consequently, 
be  failures  as  wives  and  mothers,  and  this  must  eventu- 
ally affect  the  husbands  who,  tmable  to  pay  the  ever  in- 
creasing bills,  take  to  drink  or  run  away.  And  the  cause 
of  it  all  is  refusal  to  do  useful  work. 

The  rich  are  beginning  to  recognize  the  danger  threat- 
ening them,  and  are  commencing  to  take  a  more  vital 
interest  in  life,  as  the  book  of  Townsend  Martin  on  the 
Passing  of  the  Idle  Rich  shows.  The  increased  politi- 
cal activity  of  these  women  is  to  be  welcomed  from  this 
point  of  view,  because  it  gives  them  a  new  sphere  of 
activities  more  wholesome  than  mere  amusements.  The 
more  energetic  women  of  this  class,  while  single,  are 
talking  of  definite  work  either  in  settlement  or  religious 
occupations,  because  they  do  not  want  to  degenerate  in 
the  vacuities  of  so-called  social  life.  Work  is,  thus,  both 
the  basis  and  the  preserver  of  civilization. 

There  remains  one  more  type  to  consider  briefly,  i.e., 
the  man  who  applies  his  energy  both  persistently  and 
intelligently,  but  tinsocially  and  for  the  exploitation  of 


HEALTH  AND  CIVILIZATION 


71 


others.  If  what  has  been  said  above  is  true,  not  much 
need  be  said  about  him.  The  healthy  man  we  found  to  be 
social  in  his  activities,  due  to  his  abundant  vitality.  Just 
because  his  body  is  a  well  organized  and  efficient  unity, 
he  organizes  his  work  intelligently ;  he  has  to  work  per- 
sistently owing  to  the  necessity  of  giving  a  proper  outlet 
to  his  surplus  energy.  There  is,  consequently,  no  waste- 
ful expenditure  of  energy  in  his  case,  but  well-directed 
and  effective  activities  along  lines  which  seem  worth 
while  to  him.  His  social  nature  impels  him,  however,  to 
assist  others,  and  his  abundance  of  energy  enables  him  to 
do  so ;  he  will  never  resort,  consequently,  to  the  exploita- 
tion of  others;  that  would  not  be  in  harmony  with  his 
nature  and  contrary  to  everything  that  gives  him  joy. 
If  this  be  true — and  it  can  be  verified  by  observation 
every  day — there  is  only  one  conclusion  possible  con- 
cerning the  selfish  exploiter — that  he  is  not  a  healthy  man. 
He  may  display  tremendous  energy  in  varied  and  fever- 
ish activities,  but  the  balance  of  good  health  is  lacking. 
There  is  a  peace  and  contentment,  a  joy  and  happiness 
about  the  healthy  man,  which  the  selfish  and  feverishly 
active  man  does  not  possess.  It  seems  as  if  he  wants 
to  get  something  which  he  lacks,  not  knowing  exactly 
what  it  is;  hence  his  incessant  and  carefully  planned 
activity.  The  goal  of  his  ambition  is  usually  power,  in 
whatever  form  that  may  exist  in  a  particular  society. 
Since  he  lacks  the  balanced  harmony  within  himself,  he 
seeks  it  in  the  control  of  others.  The  means  for  power 
and  control  vary  in  different  societies,  but  the  type  is 
always  the  same,  although  the  same  type  may  be  esteemed 
differently  at  different  periods.  Take  the  miser,  for 
instance.  In  olden  times  Midas  represents  the  type — 
the  grasping,  greedy  king  who  would  turn  everything  into 
gold  to  satisfy  his  lust  for  power.    But  it  was  deemed  a 


It 


72        HEALTH  AND  SOCIAL  PROGRESS 

vice  in  a  king  in  those  times  to  lust  for  power  in  the 
form  of  gold ;  power  through  the  feat  of  arms  was  the 
socially  accepted  means  for  power,  and  a  king  who  sought 
It  that  way  was  never  caricatured  as  was  Midas.     An- 
tiquity has  only  praise  for  the  Hannibals,  the  Alexanders 
and  the  Caesars.     During  the  Middle  Ages  the  socially 
accepted  means  of  seeking  power  was  the  church,  and 
anyone  seeking  it  through  warlike  exploits  was  censured 
unless  It  was  in  the  service  of  religion ;  the  man  who 
sought  It  in  gold,  was  held  up  to  public  scorn  at  least,  if 
he  was  not  persecuted.     Shylock  is  the  picture  of  the 
selfish  man  of  this  period.     In  our  own  country  the  ac- 
cepted means  of  power  is  gold ;  and  lo  and  behold  I  what 
a  change  in  popular  esteem.    The  financier  is  no  Midas 
much  less  a  Shylock ;  but  the  man  who  saves  the  countr)? 
m  times  of  panic,  barely  escapes  a  public  funeral,  and 
certainly  has  many  encomia  written  after  his  death.    The 
type  of  the  selfish  man  is  always  the  same,  i.e.,  he  is  the 
man  who  seeks  power  through  well-planned  action  by 
exploiting  others;  if  they  are  incidentally  benefited  by 
serving  as  his  tools,  he  does  not  object.     The  point  is 
that  he  seeks  a  balance  and  harmony  in  dominating  over 
others,  because  he  lacks  these  qualities.    The  interesting 
thing  from  our  point  of  view  is  that  in  some  way  the 
Volksmtind  always  caricatured  these  men  by  ascribing  to 
them   some   physical   defect.      Midas   is   thin,   haggard 
poorly  fed.  and  certainly  mad.     Shylock  is  old.  almost 
doubled  over  from  weakness,  and  certainly  obsessed  by 
money-madness.    The  financier  of  today,  being  the  man 
who  has  chosen  the  accepted  means  of  wielding  power 
IS  supposed  to  be  sleek,  well  groomed,  and  the  gentleman  ' 
par  excellence  who  favors  kings  and  emperors  with  his 
visits.    It  is  the  warrior  and  the  priest  who  are  ill-favored 
by  popular  opinion.    Anyone  familiar  with  the  popular 


HEALTH  AND  CIVILIZATION 


73 


press  of  Europe  will  recall  the  numerous  and  varied 
forms  of  ridicule  to  which  they  are  subjected  and  the 
caricatures  which  almost  invariably  intimate  some  more 
or  less  hidden  physical  defect.  The  type  has  not  changed 
psychically.  As  Alexander  used  the  soldiers  as  tools  to 
satisfy  his  selfish  ambition  for  power,  Napoleon  used  the 
French  people  for  the  same  purpose;  and  it  is  rumored 
that  certain  war-lords  of  Europe  would  do  the  same 
if  the  means  of  seeking  power  had  not  changed  from  the 
mailed  fist  to  the  hand  that  signs  checks.*  If  the  type  is 
psychically  unchanged,  may  there  not  be  some  truth  in 
the  popular  opinion  that  there  is  some  physical  defect 
lurking  somewhere  in  the  makeup  of  selfish  men,  indi- 
cating lack  of  health  and  balance?  Health  is,  conse- 
quently, the  basis  of  true  social  work. 

Civilization  is,  then,  possible  only  on  the  basis  of 
work — well  planned,  persistent,  and  intelligent.  Only 
where  work  is  recognized  as  the  proper  activity  of  every 
man,  can  there  be  true  civilization.  This  work  need  not 
be  manual  labor,  nor  industrial  or  commercial  pursuits. 
Any  activity  which  is  intelligent,  and  is  directed  toward 
raising  society  to  a  higher  level,  is  work.  And  any  society 
and  individuals  who  recognize  the  necessity  of  work  for 
the  fulfillment  of  man's  destiny  here  on  earth,  should  be 
called  civilized,  no  matter  how  poor  they  may  be.  The 
motive  for  work  must  not  come,  however,  from  the  recog- 
nition of  its  necessity  only;  it  must  be  an  impulse  from 
within  urging  man  to  exert  himself  intelligently  and 
persistently.  Where  man  works  only  because  necessity 
compels  him,  he  will  never  do  more  than  meet  that  de- 

*This  passage  was  written  before  the  recent  war  broke  out 
in  Europe.  It  would  be  interestnig  to  study  the  health  of  the 
leaders  in  this  movement.  Concerning  one  it  is  definitely  known 
that  he  has  a  poor  heredity,  is  very  excitable  and  erratic,  and 
suffers  from  megalomania. 


m 


74        HEALTH  AND  SOCIAL  PROGRESS 

mand,  and  will  remain  on  a  low  level  of  civilization. 
Where  he  seeks  an  outiet  for  his  surplus  energy  in  well 
directed  activity  for  social  ends,  and  where  he  finds  his 
joy  and  satisfaction  in  work,  a  surplus  of  goods  will 
soon  be  produced,  and  the  leisure  which  that  makes  pos- 
sible will  soon  enable  him  to  create  means  of  culture 
through  art,  science,  and  philosophy.  Such  activity  is 
possible,  however,  only  on  the  basis  of  good  health. 

The  sick  man  can  evidently  not  engage  in  work.  The 
undervitalized  man  may  try  hard  and  perhaps  wear 
himself  out  in  his  endeavor,  but  his  work  will  be  ineffi- 
cient. As  a  matter  of  fact,  the  so-called  incompetents 
consist  largely  of  this  class.  Only  healthy  men  have  the 
true  impulse  for  work;  only  they  work  efficiently,  and 
only  they  produce  more  than  is  necessary  for  their  own 
needs.  And  only  such  workers  can  enjoy  a  true  self- 
respect.  The  man  who  lives  on  other  people's  work  is  a 
parasite,  whether  he  is  a  tramp  or  a  millionaire;  he  is, 
consequently,  dependent  on  the  exertions  of  others,  and 
that  deprives  him  of  the  ability  to  be  self-respecting. 
The  man  who  does  not  "  pay  his  board  to  the  world  " 
must  get  someone  else  to  pay  it  for  him.  That  means  that 
the  wheels  of  progress  are  retarded  to  that  extent,  be- 
cause that  board  must  be  paid.  The  parsimony  of  nature 
must  be  overcome,  and  it  can  be  overcome  only  by  paying 
a  price  in  human  effort  with  physical  and  mental  energy. 
If  a  community  has  many  parasites,  it  loses  that  much 
in  actual  work  and  puts  a  heavier  burden  on  the  others 
than  they  ought  to  bear.  Worst  of  all,  though,  is  the 
lack  of  development  on  the  part  of  the  idlers,  since  effort 
is  necessary  for  development— direct,  personal  effort 
alone  will  unfold  our  powers,  since  this  cannot  be  done 
vicariously.  Our  development  is,  moreover,  the  only  thing 
worth  while  in  life,  and  everything  worth  while  must  be 


HEALTH  AND  CIVILIZATION 


75 


paid  for,  and  the  price  in  this  case  is  exertion.  Where 
the  energy  for  work  is  lacking,  there  may  be  exertion, 
but  it  will  either  be  ineffective  or  so  costly  to  the  indi- 
vidual that  development  becomes  impossible.  Hence  we 
come  back  to  the  necessity  of  heahh  from  another  point 
of  view. 

What  do  we  mean  by  development  ?  The  development 
of  an  individual  means,  briefly  stated,  his  growth  into  a 
social  person.     Professor  Giddings  says: 

"The  true  social  nature  is  susceptible  to  suggestion,  and 
imitative  and  thereby  capable  of  learning  from  fellow-beings. 
This  capacity  is  sufficient  to  make  the  social  individual  desirous 
to  live  at  least  as  well  as  the  fairly  successful  members  of  his 
community.  He  desires  to  enjoy  what  others  enjoy,  to  do 
what  others  do,  and  to  act  as  others  act. 

"The  social  nature,  however,  is  to  some  extent  originative. 
It  not  only  learns  from  others ;  it  also  teaches  others.  It  makes 
new  combinations  of  imitations;  it  makes  inventions  in  the 
sphere  of  thought  and  conduct,  and  sets  new  examples.  This 
it  is  enabled  to  do,  because,  by  varied  contact  with  many  phases 
of  life,  made  possible  by  wide  association,  it  enjoys  many 
different  experiences  which  inevitably  combine  in  peculiar  ways 
with  peculiar  results  in  the  life  of  each  separate  individual. 

"The  social  nature  is  judicious.  It  is  satisfied  that,  on  the 
whole,  the  average  judgments  of  mankind  are  justified  by  ex- 
perience. It  cannot,  to  be  sure,  be  perfectly  satisfied  with  any 
judgment,  much  less  with  all  judgments.  It  is  at  all  times  ready 
to  criticize,  to  direct,  or  to  devise ;  but  this  it  does  in  no  cranky, 
captious,  or  quixotic  way.  It  assumes  that,  for  the  purposes 
of  social  unity  and  cooperation,  men  must  respect  one  another's 
judgments;  and  that  new  beliefs  can  be  made  practically  avail- 
able only  as  large  numbers  of  men  are  converted  to  them.  The 
individual,  protesting  alone  against  the  opinions  of  his  fellow- 
members  of  society,  may  possibly  be  right,  and  they  may  be 
wrong;  but  not  until  they  are  convinced  of  error  can  he  wisely 
or  rightly  undertake  to  put  his  views  into  practical  operation. 

"  The  social  nature  is  tolerant.    It  has  learned  through  social 
experience  to  give  the  same  opportunities,  immunities,  and  en- 


pi:. 


!!? 


II 


76        HEALTH  AND  SOCIAL  PROGRESS 

joyments  to  others  that  it  claims  for  itself.  And  not  only  as 
a  matter  of  judgment  has  the  social  individual  decided  that 
toleration  is  wise,  he  has  learned  also  to  feel  as  an  experience 
of  his  emotional  nature  that  it  is  desirable  and  agreeable. 

"The  social  nature,  however,  is  not  merely  tolerant  in  the 
negative  sense  of  being  non-aggressive;  it  is  positively  sym- 
pathetic, companionable,  and  helpful.  It  enjoys  comradeship, 
communication,  social  pleasure,  and  cooperation.  It  would  be 
unhappy  in  isolation  and  dissatisfied  if  at  work  in  an  absolutely 
individual  way,  without  relation  to  the  industry  and  patriotism 
of  other  men."  i^ 

The  only  persons  who  can  meet  these  descriptions  are 
healthy   men   and   women,   since   only   these  engage   in 
spontaneous  activity,  enjoy  the  expansion  of  opportunity, 
and  experience  a  keen  pleasure  in  the  increase  of  their 
power.     This  activity  is  not  self -centered,  just  because 
their  abundance  of  vitality  enables  them  to  share  with 
others  their  own  joy  and  happiness ;  they  would,  indeed, 
be  made  miserable  if  they  had  to  live  in  an  atmosphere 
of  gloom.     Hence  by  virtue  of  their  own  nature  they 
cheerfully  scatter  sunshine  wherever  they  go.    Their  sur- 
plus energy  enables  them  to  associate  with  many  people, 
enter  many  and  varied  activities,  and  everywhere  to  learn 
something    new,    because    of    their    receptivity.      The 
devitalized  man  must  conserve  his  energy,  is  more  or 
less  concerned  about  himself,  and  he  cannot  with  the 
best   intentions   "get   away   from   himself."     U   under 
special  cases  of  excitement  he  forgets  himself,  he  mani- 
fests that  somewhat  boisterous  hilarity  which  with  women 
borders  on  and  usually  precedes  hysteria.     The  friends 
of  such  people  are  not  deceived,  since  they  know  that 
such  expenditure  of  energy  is  sure  to  bring  about  ex- 
haustion and  collapse.     The  healthy  man  increases  in 
power  as  he  associates  with  an  ever  larger  number  of 
people;  since  growth  of  personality  is  potaible  only 


HEALTH  AND  CIVILIZATION 


77 


through  exchange  of  views  with  others  and  through  the 
polishing  off  of  the  sharp  corners  and  edges  of  our 
individual  nature.  Applied  to  civilization  .this  means 
interdependence  of  peoples ;  for,  as  individuals  must  learn 
to  abide  with  each  other  by  the  circular  movement  of 
"  give  and  take  "  in  order  to  grow,  so  must  nations  enter 
into  relations  with  each  other  on  the  basis  of  fair  ex- 
change of  their  mental  achievements  as  well  as  indus- 
trial. But  travel,  whether  for  commercial  purposes  or 
scientific  investigation  or  for  the  pleasure  it  affords,  is 
ultimately  dependent  not  so  much  on  the  means  of  com- 
munication as  on  the  health  of  the  travelers  and  on  that 
of  countries.  Persons  of  low  vitality  cannot  risk  many 
journeys,  because  they  depend  too  much  on  the  comforts 
of  home ;  healthy  people  do  not  visit  regions  infested  with 
typhoid,  malaria,  or  yellow  fever.  The  Panama  district 
was  never  visited  by  pleasure  tourists  until  the  last  few 
years  when  the  Zone  had  been  made  salubrious  by  Dr. 
Gorgas.  Unhealthy  regions  prevent,  moreover,  the  pro- 
duction of  anything  else  than  raw  material,  and  thus  even 
the  commercial  traveler  is  not  attracted  to  them.  Finally, 
owing  to  their  dependence  on  others,  devitalized  people 
never  develop  that  sturdy  belief  and  confidence  in  them- 
selves, which  are  so  characteristic  of  the  healthy  man  and 
which  are  so  necessary  for  new  exploits  as  well  as  the 
undismayed  pursuit  of  more  usual  activities. 

From  whatever  point  of  view  we  look,  consequently, 
at  the  individual  or  society,  the  problem  of  health  always 
confronts  us ;  and  we  may  now  sum  up  our  results  in  a 
few  principles. 

\.  Law  of  Progress:  Progress  is  possible  only  with  a 
surplus  of  vitality  over  the  immediately  necessary  activi- 
ties of  life. 

2.  Law  of  Work:  Work  in  the  sense  of  telic  endeavor 


I 


I» 


m 


7B        HEALTH  AND  SOCIAL  PROGRESS 

and  of  the  wisely  controlled  expenditure  of  energy  is 
possible  only  with  good  health. 

3.  Law  of  Social  Personality:  The  individual  can 
grow  into  a  social  personality  only  in  proportion  as  his 
health  permits  him  to  enter  into  mutually  helpful  and 
sympathetic  relations  with  others. 

4.  Law  of  CiiHlusation:  Civilization  progresses  in 
direct  ratio  to  the  interdependence  of  persons  and 
peoples ;  i.e.,  on  the  interchange  of  mental  and  industrial 
products  which  result  from  a  healthy  individual  and 
social  life. 

5.  Law  of  General  Development:  Individuals  and  soci- 
eties develop  in  proportion  to  their  growth  in  self-reli- 
ance ;  and  this  depends  upon  their  ability  to  attain  health 
with  the  resuhant  confidence  in  their  ability  to  control 
nature  and  their  own  destiny. 


PART  II 


SPECIFIC  CASES  OF  HEALTH  IN  RELA- 

TION  TO  SOCIETY 


CHAPTER  VI 


l|i 


HEALTH  AND  ANCIENT  GREECE 

Man  is  bound  to  earth.    Like  Antaeus  of  old,  he  gains 
strength  every  time  he  touches  her ;  and  like  Brutus,  he 
must  recognize  her  as  the  mother  of  us  all.    In  proportion 
as  she  is  kind  and  liberal  with  her  gifts,  he  prospers  and 
develops,  and  in  proportion  as  she  is  niggardly,  he  be- 
comes stunted  in  mind  and  body.    Some  mothers  give  too 
much,  and  spoil  their  children ;  others  give  too  little,  and 
hinder  their  development ;  others  again  give  enough  but 
not  too  much,  and  thus  favor  the  development  of  initiative 
through ''mental  and  physical  activity.     So  nature  is  a 
"  lady  bountiful "  in  some  places,  in  others  a  hard  step- 
mother, in  others  again  a  wise  and  kindly  mother  who 
knows  that  over-indulgence  is  evil  and  that  niggardliness 
may  prove  disastrous  to  the  welfare  of  her  children. 
But  however  nature  may  treat  her  children,  they  are 
always  her  offspring,  and  bear  the  marks  of  her  different 
attitudes  in  the  tropics  as  much  as  in  the  arctics;  for 
they  can  never  completely  free  themselves  from  the  in- 
fluences which  she  is  constantly  impressing  upon  them. 
This  dependence  upon  natural  influences  has  led  social 
scientists  to  the  conclusion  that  happenings  in  the  social 
and  political  sphere  are  not  the  result  of  chance,  of  indi- 
vidual impulse  or  caprice,  nor  of  the  direct  interference 
of  an  infinite,  and  often  arbitrary  power.     History  in 
our  times  is  not  written  as  that  of  Herodotus,  or  of  the 
Chronicler  among  the  ancient  Hebrews,  who  ascribed 
every  happening  to  the  good  or  ill  will  of  God.    We 


w 


82        HEALTH  AND  SOCIAL  PROGRESS 

have  learned  that  nature  is  orderly  because  ruled  by  law  ; 
and  so  we  are  learning  that  social  happenings  occur  in  an 
orderly  and  law-abiding  manner,  just  because  man  is 
nature's  oflFspring.  We  have  not  yet  proceeded  far 
enough  in  this  new  field  to  foretell  with  the  exactness  of 
astronomy  the  future  of  social  events,  but  we  know  that 
the  origin,  growth,  decay,  or  retardation  of  institutions 
may  be  aided  or  hindered  by  man  according  to  his  knowl- 
edge of  nature's  laws.  In  proportion  as  we  realize  this 
fact,  shall  we  succeed  in  shaping  our  own  destiny, — "  to 
see  in  order  to  forsee  "  as  Comte  said,  to  avoid  harmful 
things  and  provide  for  advantageous  ones. 

Man's  dependence  on  nature  might  be  illustrated  from 
many  points  of  view,  as  Buckle,  Ratzel,  and  Huntington 
have  done.  The  only  point  with  which  we  are  concerned 
is  that  of  health,  and  the  Greeks  and  Romans  will  serve 
as  a  sufficient  proof  of  its  importance  for  national  wel- 
fare. This  statement  should,  of  course,  be  understood 
just  as  it  stands — importance  for  national  welfare — since 
no  attempt  will  be  made  to  explain  Greek  and  Roman 
genius  from  geographical  conditions,  because  explanations 
of  that  kind  are,  to  say  the  least,  one-sided  and  forced,  as 
the  theories  of  Buckle  and  Ratzel  prove.  With  our 
present  imperfect  knowledge  of  the  relation  of  body  and 
mind,  it  is  premature  to  attempt  an  explanation  of  civili- 
zation on  the  basis  of  any  one  factor.  Life  is,  after  all, 
not  a  theory,  but  a  bundle  of  facts.  Until  we  know  at 
least  the  majority  of  these  facts  scientifically,  our  theories 
will  always  be  colored  by  our  philosophies,  and  these 
represent  distinctly  individual  views  and  not  generally 
accepted  theories  of  life. 

That  health  is  necessary  for  civilization,  the  Greeks 
and  Romans  prove  abundantly  since  no  other  peoples 
believed  so  strongly  in  the  theory  of  Mens  sana  in 


I 


HEALTH  AND  ANCIENT  GREECE         83 

corpore  sano.  Their  training  aimed  at  the  best  possible 
development  of  the  body,  and  for  a  long  time  they  suc- 
ceeded. Then  a  disease  entered  their  countries,  and 
attacked  them,  and  as  they  were  unable  to  cope  with  it, 
they  lost  virility  and  buoyancy  of  body  and  mind;  the 
surplus  of  energy  which  had  been  stored  up  was  soon 
exhausted,  and  the  decadence  of  their  civilization  com- 
menced almost  immediately.  This  disease  was  malaria. 
There  were  undoubtedly  other  diseases,  both  individual 
and  social,  which  contributed  to  this  result ;  but  we  are 
unable  to  lay  our  finger  as  definitely  upon  them  as  on  this 
particular  disease. 

In  an  attempt  to  prove  this  theory,  six  questions  must 
be  answered:  (1)  Does  malaria  produce  such  deleterious 
results  as  the  theory  calls  for?  (2)  Was  there  any 
marked  deterioration  of  the  Greek  character  at  a  par- 
ticular time?  (3)  Is  there  any  specific  cause  that  can  be 
assigned  as  a  reason  for  such  a  result  ?  (4)  If  malaria 
was  the  cause,  when  was  it  introduced?  (5)  How  did 
it  affect  the  Greeks?  (6)  Why  were  the  effects  so 
disastrous?  The  first  of  these  questions  has  a  general 
application,  and  the  answer  of  modern  medicine  covers 

any  people. 

(1)  Does  malaria  produce  such  deleterious  results  as 

the  theory  calls  for? 

A  full  statement  by  a  physician,  William  H.  Deaderick, 
who  has  been  engaged  in  private  practice  in  country  dis- 
tricts, in  the  home  of  the  severer  forms  of  the  disease  in 
Arkansas,  will  serve  the  purpose  of  proving  the  disastrous 
character  of  malaria  better  than  a  discussion  by  a  layman. 

"Malaria  has  been  one  of  civilization's  greatest  foes,  both 
in  time  of  war  and  in  peace.  Where  shot  and  shell  have  slain 
their  thousands,  malaria  has  slain  its  tens  of  thousands.  Malaria 
is  the  chiefUin  of  the  army  of  disease.    Even  Napoleon  acknowl- 


ii\ 


84         HEALTH  AND  SOCIAL  PROGRESS 

edged  its  supremacy  when  he  wrote  his  minister  of  war  on 
the  occasion  of  the  disastrous  English  Walcheren  expedition: 
*  We  are  rejoiced  to  see  that  the  English  themselves  are  in  the 
morasses  of  Zealand.  Let  them  be  kept  only  in  check,  and  the 
bad  airs  and  fevers  peculiar  to  the  climate  will  soon  destroy 
their  army.*  It  is  said  that  the  French  crowed  over  the  expedi- 
tion '  with  the  force  of  reason,  the  bitterness  of  sarcasm,  and 
the  playfulness  of  ridicule.'  How  accurately  Napoleon's  pre- 
diction was  verified  is  well  known. 

"  In  the  tropics,  the  man  who  works  the  soil  digs  his  own 
grave.  Gigantic  commercial  enterprises  have  been  undertaken 
and  then  abandoned  on  account  of  the  havoc  wrought  by  this 
scourge.  Only  recently  has  it  been  recognized  that  the  medical 
man  must  precede  and  prepare  the  way  for  the  engineer  and 
the  laborer. 

"But  warring  and  canal  digging  are  not  the  only  conditions 
under  which  the  malarial  tragedy  is  enacted.  Within  the  family, 
at  home,  the  disease  appears  in  a  varied  succession  of  forms, 
rapidly  fatal  or  slowly  sapping  the  vitality,  influencing  the  birth 
rate,  longevity,  and  even  the  intelligence  and  morality  of  entire 
countries. 

"  In  highly  malarial  regions,  as  the  mortality  increases,  natality 
diminishes  on  account  of  abortions  and  sterility.  Premature 
senility  is  frequent  and  advanced  age  is  not  so  commonly 
attained. 

"Malaria,  leaving  its  subjects  anannic  and  neurotic,  is  re- 
sponsible for  inertia,  loss  of  will  power,  intemperance,  and 
general  mental  and  moral  degradation.  Jones,  who  maintains 
that  malaria  was  a  potent  factor  in  the  decline  of  Greece  and 
Rome,  concludes  that  'malaria  made  the  Greek  weak  and  in- 
efficient; it  turned  the  sturdy  Roman  into  a  bloodthirsty  brute.* 
Monfalcon  attributed  abortion,  infanticide,  universal  libertinism, 
drunkenness,  want  of  religion,  gross  superstition,  assassina- 
tion, and  other  crimes  to  the  direct  influence  of  malaria. 

"Malaria  costs  the  South  incalculable  wealth.  Besides  loss 
through  untilled  acres,  diminished  earning  capacity,  loss  of  time, 
and  death,  it  produces  in  its  victims  a  disinclination  for  work 
whose  influence  cannot  be  estimated  in  money.  A  conservative 
computation  of  the  loss  to  the  Southern  States  through  malaria 
is  fifty  million  of  dollars,  annually. 
"The  importance   to   the  world  at   large  of  the   subject  of 


HEALTH  AND  ANCIENT  GREECE 


85 


malaria  is  evidenced  by  the  fact  that  two  of  the  seven  Nobel 
prizes  in  medicine  which  have  been  awarded  have  been  granted 
for  discoveries  in  malaria,  to  Ross  in  1902,  and  to  Laveran 
in  1907.' 


18 


A  third  Nobel  prize  was  awarded  to  a  malaria  specialist 
in  1906,  namely  Golgi. 

This  general  description  of  the  effects  of  malaria  may 
be  supplemented  by  its  special  effects.  These  vary  some- 
what according  to  climate,  physical  susceptibility,  and 
type  of  fever.  Quotations  from  Sir  Patrick  Manson  will 
again  best  serve  the  purpose  of  showing  the  nefarious 
character  of  malaria. 

"  But,  as  there  may  be  an  infinite  variety  as  regards  the  num- 
ber of  parasites  present,  individual  susceptibility,  concurrence 
of  several  species  (mixed  infection  being  far  from  common), 
or  of  several  generations  of  the  same  species  of  parasite 
maturing  at  different  times,  there  may  be  a  corresponding 
variety  in  the  clinical  manifestations."  1® 

Of  the  "  bilious  remittent "  form  of  malaria  he  says : 

"  These  bilious  remittents  are  very  common  in  the  more 
highly  malarious  districts  of  Africa,  America,  the  West  Indies, 
India,  and,  in  fact,  in  all  malarious  countries.  They  are  not 
specially  nor  directly  dangerous  in  themselves,  but  they  result 
usually  in  profound  anaemia,  and  are  often  but  the  prelude  to 
chronic  malarial  saturation,  bad  health,  and  invaliding."  20 

Concerning  "  adynamic  remittent "  our  author  says  that 
there  are: 

"Cases  which  are  characterized  by  fatuousness,  restlessness, 
nervous  depression,  intense  muscular  and  cardiac  debility,  pro- 
found and  rapid  blood  deterioration  .  .  .  and  a  marked  tendency 
to  local  gangrene."  2* 

Among  the  "pernicious  attacks"  there  are  various 
"  cerebral  forms  "  which  are  generally  dangerous. 


\  i 


i  (■ 


i 


85        HEALTH  AND  SOCIAL  PROGRESS 

"  Seizures  of  this  description,  if  not  fatal,  may  eventuate  in 
permanent  psychical  disturbances.  Temporary  debility  or  even 
complete  loss  of  memory  may  succeed  severe  malarial  infec- 
tion." 22 

Similar  statements  are  made  about  other  types  of 
malaria.  The  blood  is  attacked  by  the  parasite  and  we 
have  a  deterioration  and  diminution  of  the  red  cor- 
puscles. Among  the  results  of  malaria  Sir  Patrick  Man- 
son  mentions  enlargement  of  the  spleen  and  liver,  de- 
generation of  the  heart,  and  other  after-effects. 

Dr.  Deaderick  thus  describes  persons  suflFering  from 
malarial  cachexia. 

"The  cachectic  usually  presents  a  singular  appearance.  The 
emaciated  limbs  are  in  marked  contrast  to  the  big  belly,  and 
the  features  are  aged  beyond  the  years.  The  most  pronounced 
phenomena  are  the  anaemia  and  the  enlarged  spleen.  The  red 
blood-cells  may  be  reduced  to  seven  or  eight  hundred  thousand 
per  cmm."  *• 

The  true  mortality  from  malaria  is  difficult  to  esti- 
mate, because  of  the  variety  of  forms  which  malaria 
assumes  and  its  complications  with  other  diseases.  Dr. 
Deaderick  states  that  out  of  5,109,001  cases,  148,055  or 
2.89  per  cent  ended  fatally.  These  figures  report  evi- 
dently light  cases,  since  according  to  other  figures  given 
by  him  there  were  7,205  fatalities  out  of  27,039  cases, 
or  over  26  per  cent;  while  different  writers  whom  he 
quotes  state  the  mortality  from  some  forms  of  malaria  to 
be  as  high  as  50  per  cent,  and  even  higher.'*  Concern- 
ing mortality  from  malarial  cachexia;  he  says: 

"  The  mortality  varies  unaccountably  from  year  to  year,  some 
seasons  evincing  a  series  of  mild  cases,  others  an  appalling 
mortality.  In  a  certain  parish  of  Louisiana  in  1867,  many  cases 
are  said  to  have  occurred,  of  which  not  less  than  95  per  cent 


HEALTH  AND  ANCIENT  GREECE 


87 


died.  Fisch,  who  placed  the  mortality  on  the  Gold  Coast  at 
20  per  cent,  states  that  until  two  or  three  decades  previously 
nearly  all  who  were  attacked  died."  26 

Another  dangerous  characteristic  of  malaria  is  the 
impossibility  of  acquiring  immunity  from  it,  since  very 
few  individuals  even  among  the  negroes  in  Africa  are 
absolutely  immune,  and  this  freedom  from  the  disease  is 
not  hereditary.  The  negroes,  the  Chinese,  the  Malays, 
and  other  dark-skinned  races  enjoy  comparative  immun- 
ity, while 

''The  inhabitants  of  the  malarious  districts  of  Italy,  Corsica, 
Greece,  Turkey,  and  other  South  European  countries  have  in- 
herited no  marked  immunity  from  malaria  in  virtue  of  the 
thousands  of  years  during  which  their  ancestors  lived  in  malari- 
ous districts."  2« 

Children  up  to  three  or  four  years  harbor  almost 
without  exception  malaria  parasites.  The  proportion  of 
infected  children  gradually  becomes  smaller  until  ado- 
lescence is  approached,  when  the  blood  becomes  prac- 
tically free  from  parasites  and  partial  immunity  is  estab- 
lished. This  process  is,  however,  bought  dearly,  since  the 
mortality  in  children  native  to  highly  malarious  countries 
is  very  great.  Concerning  the  health  of  the  immunes 
authorities  differ.    Manson  says : 

"  It  has  often  been  remarked  that  these  dark-skinned  children, 
with  enormous  spleens  and  a  rich  stock  of  malaria  parasites  in 
the  blood,  run  about  fever-free,  and  apparently  in  rude  health."  *' 

Major  Ross,  however,  says: 

"An  intensely  malarious  locality  cannot  thrive.  The  children 
arc  wretched,  the  adults  frequently  racked  with  fever,  and  the 
whole  place  shunned  whenever  possible  by  the  neighbors.    The 


t 


It  *  ■ 


f  'H 


88        HEALTH  AND  SOCIAL  PROGRESS 

landowner,  the  traveler,  the  innkeeper,  the  trader  fly  from  it 
Gradually  it  becomes  depopulated  and  untitled,  the  home  only 
of  the  most  wretched  persons."** 

Even  if  immune  children  enjoy  rude  health,  their 
enormous  spleens  indicate  a  serious  disturbance  in  the 
physical  system,  sufficient,  perhaps,  to  prevent  the  build- 
ing up  of  a  fine-grained  nervous  system  which  is  neces- 
sary for  the  creation  of  a  higher  civilization. 

Of  greater  significance  is  local  immunity,  since  these 
islands  of  malaria-free  localities  are  important,  as  will 
appear  later.  Bermuda,  Argentina,  New  Zealand,  and 
the  Sandwich  Islands  are  remarkably  exempt  from  this 
disease.  Even  in  malarial  countries  such  as  India,  im- 
mune localities  are  found,  e.g.,  Kherwara  in  Rajputana. 
Generally  speaking,  high  altitudes  are  relatively  exempt 
even  though  surrounded  by  malarial  lowlands.  A  few 
hundred  feet  in  altitude  may  show  a  more  marked  dif- 
ference in  the  prevalence  of  malaria  than  as  many  miles  in 
latitude.  In  the  tropics  where  even  high  elevations  do 
not  have  a  low  temperature,  malaria  may  be  found  at 
elevations  of  6,000  or  7,000  feet,  and  other  circumstances 
may  annul  the  advantages  of  elevation. 

"In  Italy  there  are  many  malarious  spots  high  up  among  the 
hills;  the  same  is  the  case  in  India,  and  elsewhere  in  these 
elevated  valleys  which  are  also  narrow,  imperfectly  ventilated 
and  imperfectly  drained."  29 

With  the  exception  of  these  few  localities,  malaria 
is  prevalent  all  over  the  tropics  and  in  most  parts  of  the 
temperate  zones.  Its  debilitating  influences  have,  in  other 
words,  been  spread  over  the  larger  part  of  the  habitable 
globe,  as  will  be  seen  from  the  geographic  distribution 
given  by  Dr.  Deaderick.^®  Summarizing  this  report,  we 
find  malaria  to  be  very  prevalent  in  the  southeastern  por- 


HEALTH  AND  ANCIENT  GREECE         89 

tion  of  the  United  States,  less  prevalent  along  the  At- 
lantic coast  south  of  New  York  with  increasing  fre- 
quency as  we  go  south.  The  Mississippi  valley  along 
both  shores  to  the  extent  of  hundreds  of  miles,  is  very 
malarious,  as  are  all  the  Gulf  States.*  In  New  York, 
Pennsylvania,  and  New  England  autochthonous  cases  are 
found,  while  the  shores  of  the  Great  Lakes  and  the 
Central  States  are  comparatively  free,  with  the  exception 
of  the  lowlands.  On  the  Pacific  coast  malaria  is  not 
frequent,  but  all  the  river  valleys  harbor  numerous  in- 
fected mosquitos.  In  Mexico  severe  forms  of  malaria 
occur,  particularly  in  the  low  coast  regions.  The  Atlantic 
side  of  Central  America  is  most  unhealthy  owing  to 
malaria,  and  the  Pacific  coast  is  only  slightly  less  so. 

In  South  America  the  larger  part  of  Brazil,  Venezuela, 
Guiana,  are  highly  malarious;  Bolivia,  Paraguay,  and 
Uruguay  are  less  infected,  while  Argentina  is  almost 
entirely  free.  The  deep  valleys  of  Peru,  Ecuador,  and 
of  some  portions  of  Chile  are  malarious  centers.  All  of 
the  islands  in  the  Greater  and  Lesser  Antilles  are  malari- 
ous, while  Bermuda  is  practically  free  from  this  disease. 

In  Europe,  Great  Britain  is  now  free  from  malaria, 
and  Germany  has  infrequent  cases  along  the  Rhine  and 
Danube  valleys;  but  Holland  has  many  cases,  both  in 
its  northern  and  southern  portions,  particularly  on  the 
island  of  Zealand.  The  valley  of  the  Danube  in  Austria 
and  Hungary  has  many  cases  of  malaria,  and  many  other 
portions  of  Hungary  are  heavily  infected.  In  France, 
malaria  is  found  chiefly  in  the  marshy  land  along  the 
west  coast  and  in  the  south;  Spain  and  Portugal  have 

*The  State  of  Mississippi  reported  158,000  cases  in  IQI?- 
But  this  is  only  a  small  part  of  those  occurring,  since  only  about 
ten  per  cent  of  the  physicians  answered  the  questionnaire  of 
the  United  States  Public  Health  Service,  and  many  more  cases 
were  not  attended  by  physicians. 


90 


HEALTH  AND  SOCIAL  PROGRESS 


'•I;   I 


numerous  cases  in  the  coast  regions  and  the  larger  river 
valleys.  In  Russia,  malaria  is  encountered  along  the 
coasts  of  the  Black  Sea  and  the  rivers  which  issue  into  it. 
Bulgaria  is  very  malarious  in  its  southern  part,  along  the 
Danube  and  coast  regions.  Practically  all  parts  of  Italy, 
Sicily,  and  Sardinia  are  afflicted  with  this  disease,  and 
some  portions  of  southwestern  Switzerland.  Greece  is 
severely  scourged  with  malaria,  and  in  some  parts 
scarcely  any  inhabitants  escape. 

Few  countries  of  Asia  are  free  from  this  disease ;  Asia 
Minor,  Arabia,  and  Persia,  the  swampy  regions  of 
Afghanistan  and  Beloochistan  have  many  and  severe 
cases  of  malaria.  The  presidencies  of  Bengal  and  Bom- 
bay, the  foothills  of  the  Himalayas,  and  other  parts  of 
India  are  intensely  malarial.  Ceylon  is  endemic  terri- 
tory, and  so  are  Burmah,  Siam,  the  Malay  Peninsula,  and 
French  Indo-China.  Some  parts  of  China  are  intensely 
infected;  Japan,  Formosa,  and  the  Philippines  give  rise 
to  malaria. 

In  Africa,  the  territory  between  the  Senegal  and  Congo 
rivers  is  headquarters  for  a  malignant  type  of  this  disease, 
while  further  south  the  cases  become  less  frequent  and 
severe.  All  along  the  east  coast  from  Delagoa  Bay  to 
Eritrea  is  malarial  country,  including  the  larger  part  of 
Madagascar  and  Mauritius.  The  interior  of  Central 
Africa,  excepting  the  high  plateaus,  is  all  malarious 
country.  In  the  Nile  valley  the  inundated  portions  are 
very  malarious,  and  the  disease  abounds  along  the  coast 
and  in  the  marshes  of  Algeria. 

In  Australia,  malaria  occurs  all  along  the  coasts,  dimin- 
ishing towards  the  south. 

The  whole  of  Canada,  Norway,  and  Sweden,  are 
practically  free  from  the  disease.  These  localities  arc 
always  looked  upon  as  healthy,  and  are  frequented  by 


HEALTH  AND  ANCIENT  GREECE 


91 


many  visitors;  and  the  inhabitants  are  usually  energetic 
and  well  advanced  in  education. 

The  zone  of  malaria  is  almost  coincident  with  the 
tropics  and  the  larger  portion  of  the  temperate  zones; 
it  has,  consequently,  been  a  danger  and  enemy  of  man 
since  early  times.  The  relief  felt  by  physicians  when 
this  obstacle  to  good  health  was  removed  by  the  epoch- 
making  discovery  of  Ross,  and  when  the  possibility  of 
exterminating  the  disease  was  in  sight,  is  perhaps  best 
expressed  by  a  quotation  from  Dr.  Deaderick. 

"Undertaking  the  work  at  Manson's  suggestion,  and  after 
several  years  (1895-1898)  of  toil  and  discouragement,  Ross 
proved  conclusively  that  certain  species  of  mosquitos  are  con- 
cerned in  the  dissemination  of  malaria.  The  debt  owed  him 
by  mankind  was  acknowledged  by  the  gift  of  a  Nobel  prize; 
his  own  feelings  over  the  discovery  are  expressed  in  these  lines 
which  he  wrote: 


tt 


*This  day  relenting  God 
Hath  placed  within  my  hand 
A  wondrous  thing,  and  God 
Be  praised.    At  His  command 


M  t 


Seeking  His  secret  deeds 
With  tears  and  toiling  breath, 
I  find  thy  cunning  seeds, 
Oh  million-murdering  death. 

*•'!  know  this  little  thing 
A  myriad  men  will  save; 
Oh,  death,  where  is  thy  sting, 
Thy  victory,  O  grave?'"" 

The  first  question  having  been  answered,  we  may  now 
proceed  to  the  second  in  regard  to  the  deterioration  of 
Greek  character  at  a  particular  time. 

(2)  Was  there  a  deterioration  of  Greek  character  at 
a  particular  time? 


•Mil. 


r. 


m 


I 


h; 


92        HEALTH  AND  SOCIAL  PROGRESS 

In  order  to  simplify  the  discussion  of  this  question, 
a.  caution  should  be  inserted  at  the  very  beginning. 
Whether  malaria  existed  in  other  parts  of  Greece  prior 
to  500  B.C.  is  still  a  problem  waiting  for  solution.  That 
it  did  not  exist  in  Attica  is  fairly  certain,  owing  partly 
to  its  location  and  partly  to  the  absence  of  references  to 
this  disease  by  Athenian  writers.  The  testimony  of  the 
latter  will  be  taken  up  later,  but  a  brief  statement  must 
be  made  here  about  the  location  of  Attica  as  favoring  the 
theory  that  it  was  free  from  malaria. 

Attica  was  most  probably  one  of  those  favored  locali- 
ties just  mentioned,  which,  owing  to  its  situation,  was 
free  from  this  disease.  The  advantageous  features  of 
this  situation  are  from  the  present  point  of  view,  two: 
a  comparatively  dry  climate,  and  a  location  off  the  main 
road  of  travel  between  north  and  south.  The  former 
feature  would  be  unfavorable  to  the  development  of 
indigenous  malaria,  the  latter  to  its  introduction  from 
other  regions. 

"In  ancient  Greece  the  fruitful  plains  of  Thessaly,  Boeotia, 
Elis,  and  Laconia  had  a  fatal  attraction  for  every  migrating 
horde ;  Attica's  rugged  surface,  poor  soil,  and  side-tracked  loca- 
tion off  the  main  line  of  travel  between  Hellas  and  the  Pelopon- 
nesus saved  it  from  many  a  rough  visitant,  and  hence  left  the 
Athenians,  according  to  Thucydides,  an  indigenous  race.»2 

Athens  will  consequently  be  the  only  part  considered 
in  this  discussion,  since  it  is  to  her  that  we  owe  practically 
all  the  arts  and  philosophy,  which  have  survived  into 
modern  times. 

Galton  states  that  Athens  built  up,  by  a  system  of 
unconscious  but  judicious  selection,  a  magnificent  breed 
of  men,  which  produced  in  the  space  of  a  century — 530 
to  430  B.C.— the  following  fourteen  illustrious  men. 


.'! 


HEALTH  AND  ANCIENT  GREECE         93 

"Statesmen  and  Commanders.— Themistocles  (mother  an 
alien),  Miltiades.  Aristides,  Cimon  (son  of  Miltiades),  Pericles 
(son  of  Xanthippus,  the  victor  at  Mycale). 

"Literary  and  Scientific  Men.— Thucydides,  Socrates,  Xeno- 
phon. 

**  Poets.— iEschylus,  Sophocles,  Euripides,  Aristophanes. 

"  Sculptor.— Phidias."  ^a 

His  argument  is  that  a  free-born  population  of  about 
90,000  persons,  within  a  century,  produced  an  exceed- 
ingly large  proportion  of  prominent  men.  This  is  cer- 
tainly true.  But  it  is  interesting  to  note  that  not  a  single 
man  is  included  in  that  list  after  430  B.C.  He  might, 
of  course,  have  added  Aristotle,  Demosthenes,  and  a  few 
others  who  lived  later.  In  his  mind  he  &ees,  however, 
a  sudden  drop  in  the  production  of  great  Athenians  about 
this  time.  And  he  proceeds  to  give  his  reasons  for  this 
result. 

"We  know,  and  may  guess  something  more,  of  the  reason 
why  this  marvclously-gifted  race  declined.  Social  morality  grew 
exceedingly  lax;  marriage  became  unfashionable,  and  was 
avoided,  many  of  the  more  ambitious  and  accomplished  women 
were  avowed  courtesans,  and  consequently  infertile,  and  the 
mothers  of  the  incoming  population  were  of  a  heterogeneous 
class.  In  a  small  sea-bordered  country  where  emigration  and 
immigration  are  constantly  going  on,  and  where  the  manners 
are  so  dissolute  as  were  those  of  Greece  in  the  period  of  which 
I  speak,  the  purity  of  a  race  would  necessarily  fail.*'** 

This  quotation  assigns  two  reasons  as  the  cause  of 
Greek  degeneration :  moral  laxity  and  loss  of  social  purity. 
The  first  reason  has  generally  been  employed  by  his- 
torians and  moralists,  and  yet  it  is  not  true  to  the  facts. 
Mental  and  moral  degeneracy  is  an  effect  rather  than  a 
cause.  People  become  mentally  and  morally  unstable 
through  loss  of  physical  balance  by  means  of  illness  and 


94        HEALTH  AND  SOCIAL  PROGRESS 

disease,  and  immorality  simply  hastens  dissolution  al- 
ready begun.  Lack  of  physical  health  is  always  the 
primary  and  principal  cause,  if  we  are  to  trust  modem 
scientific  investigations.* 

The  second  reason  is  more  true  to  the  facts,  but  the 
cause   assigned    for   it   is   wrong.      It   is   a   sociological 
principle  that  men  of  a   superior   race  do  not   marry 
women  of  an  inferior  race,  unless  women  of  their  own 
race  are  not  available ;  only  inferior  men  marry  women  of 
an  inferior  race  when  women  of  their  own  race  are 
available.    It  may  be  granted  that  a  number  of  Athenian 
women   preferred   the    free   life  of    hetaerae,   but   their 
number  must  have  been  small.    The  very  fact,  moreover, 
that  they  preferred  that  life,  is  an  indication  of  their  lack 
of  physical  and,  consequently,  moral  balance.    Breeding 
from  them  would  only  have  hastened  the  process  of  de- 
generation.   We  have  to  fall  back,  therefore,  on  the  argu- 
ment from  lack  of  physical  balance  or  low  vitality  which 
resulted  from  a  disease  newly  introduced  into  Athens. 
It  was  the  inability  to  account  for  the  decay  of  Athe- 
nian genius  on  any  other  basis,  which  induced  Mr.  Jones 
and  Major  Ross  to  seek  for  some  specific  disease,  in- 
troduced about  this  time,  that  might  explain  the  decline 
of  Athens.     Mr.  Jones  found  that  immorality  did  not 
increase  between  500  and  300  b.c,  but  that  the  character 
of  the  people  changed — home-life  taking  precedence  over 
civic  life,  sentimentalism  replacing  robust  feeling  in  art, 
and  pessimism  supplanting  optimism  in  philosophy. 

♦The  grave  injury  of  sexual  immorality  is  due  chiefly  to 
venereal  diseases,  and  of  these  syphilis  is  the  more  injurious 
owing  to  its  hereditary  and  pervasive  character.  It  was,  how- 
ever, unknown  in  Europe  before  1495  and  cannot  be  charged 
with  the  extensive  deterioration  among  the  Greeks  and  Romans, 
although  both  were,  at  least  in  their  later  history,  grossly  im- 
moral. (See  The  Nation's  Health,  by  Sir  Malcolm  Morris,  M.D., 
New  York,  1917,  pp.  12-15.) 


HEALTH  AND  ANCIENT  GREECE         95 

"There  does  not  appear  to  have  been  any  increase  of  immo- 
rality between,  say,  500-300  b.c.  But,  nevertheless,  morality 
changed.  Home  life  took  precedence  of  city  life,  patriotism 
decayed,  and  lofty  aspirations  almost  ceased  to  stir  the  hearts 
of  men.  In  art  there  appeared  a  tendency  to  sentimentalism; 
philosophy  in  many  quarters  became  distinctly  pessimistic.  Some 
schools  of  thought  actually  regarded  'absence  of  feelings'  or 
'absence  of  care'  as  the  highest  goal  of  human  endeavor. 
Dissatisfaction  and  querulousness  are  marked  characteristics 
of  the  age.  By  300  b.c.  the  Greeks  had  lost  much  of  their  manly 
vigor  and  intellectual  strength. 

'•  The  cause  of  this  change  appeared  to  the  present  writer  to 
be  partly  the  decay  of  religious  feeling,  and  partly  the  growth 
of  the  human  intelligence,  which  resulted  in  dissatisfaction  with 
existing  institutions.  Doubtless  both  of  these  tendencies  were 
factors  in  the  change,  but  they  did  not  seem  at  the  time  of 
writing  the  earlier  essay,  and  they  do  not  seem  now,  to  be 
sufficient  by  themselves."  ^^ 

Whatever  one  may  think  of  the  reasons  assigned  for 
the  decay  of  Greek  genius,  degeneration  is  admitted  to 
have  begun  about  the  year  400  b.c.  This  fact  is,  more- 
over, borne  out  by  evidence  of  contemporaries,  of  whom 
Demosthenes  may  serve  as  a  good  example.  In  the  first 
Philippic,  delivered  in  352  B.C.  he  thus  addresses  his 
fellow-citizens.  "  When,  then,  O  Athenians,  will  you  be 
about  your  duty  ?  Will  you  always  roam  about  the  public 
places  asking  one  of  another:  What  is  the  news?  Ah! 
How  can  there  be  anything  newer  than  the  sight  of  a 
Macedonian  conquering  Athens  and  dominating  Greece? 
I  say,  then,  that  you  ought  to  equip  fifty  galleys  and 
resolve,  if  necessary,  to  man  them  yourselves.  Do  not 
talk  to  me  of  an  army  of  10,000  or  of  20.000  aliens  that 
exist  only  on  paper.    I  would  have  only  citizen  soldiers." 

In  the  third  Philippic  (341  B.C.),  Demosthenes  had 
reason  to  chide  the  Athenians  for  their  continued  in- 
action.   "  When  the  Greeks  once  abused  their  power  to 


1 ; 


96 


HEALTH  AND  SOCIAL  PROGRESS 


oppress  others,  all  Greece  rose  to  prevent  this  injustice; 
and  yet  today  we  suffer  an  unworthy  Macedonian,  a 
barbarian  of  a  hated  race,  to  destroy  cities,  celebrate  the 
Pythian  games,  or  have  them  celebrated  by  his  slaves. 
And  the  Greeks  look  on  without  doing  anything,  just  as 
one  sees  hail  falling  while  he  prays  that  it  may  not  touch 
him.  You  let  him  increase  his  power  without  taking  a 
step  to  stop  it,  each  regarding  it  as  so  much  time  gained 
when  he  is  destroying  another,  instead  of  working  and 
planning  for  the  safety  of  Greece,  when  everybody  knows 
that  the  disaster  will  end  with  the  inclusion  of  the  most 
remote." 

An  address  of  this  kind  would  have  been  impossible 
in  490  B.C.,  when  10,000  Athenian  citizen  soldiers  routed 
the  much  more  numerous  Persians  at  Marathon ;  or  even 
in  400  B.C.  when  10,000  Greeks  marched  through  the 
whole  Persian  empire  and  lost  only  2,000  men  within  a 
year  of  constant  fighting  against  treacherous  enemies  and 
hostile  elements.  In  about  50  years  the  character  of  the 
Greeks  had  deteriorated  sufficiently  to  call  for  the  sharp 
rebuke  of  Demosthenes. 

(3)  Is  there  any  specific  cause  that  may  explain  this 
result  ? 

Modern  times  have  witnessed  the  wholesale  de- 
struction of  many  nature-peoples,  e.g.,  the  Caribbeans 
and  the  Indians.  Their  extinction  was  due  not  so  much 
to  the  arms  of  the  white  men,  as  to  the  introduction  of 
new  diseases,  which,  although  comparatively  mild  ordi- 
narily among  the  whites,  assumed  the  character  of  a 
plague  among  people  whose  constitutions  were  unpre- 
pared for  these  particular  forms  of  disease. 

"  I  have  heard  that  not  so  long  ago  a  third  of  the  Andamanese 
Islanders  were  swept  away  by  measles.  Whole  populations  have 
disappeared  before  smallpox  and  syphilis;  and   I  suspect  that 


HEALTH  AND  ANCIENT  GREECE         97 

tuberculosis  has  had  a  marked,  but  as  yet  undetermined,  effect 
on  the  world's  history."  3« 

Malaria  is  not  considered  a  virulent  disease  in  modem 
times,  because  we  have  a  specific  in  cinchona.  Among 
nature-peoples,  it  often  proves  very  disastrous,  especially 
when  newly  introduced. 

"A  fever  visitation  about  the  year  1830  was  officially  esti- 
mated to  have  killed  70,000  Indians  in  California,  while  at  about 
the  same  time  a  malarial  fever  epidemic  in  Oregon  and  on  the 
Columbia  river,  ravaged  the  tribes  of  the  region  and  practically 
exterminated  those  of  Chinookan  stock."  ^^ 

Dr.  G.  Archdall  Reid  attributes  the  disappearance  of 
most  nature-peoples  to  the  epidemic  effect  of  diseases, 
introduced  among  them  by  civilized  men,  among  whom 
they  are  endemic.  The  virulence  of  a  disease  among  a 
people  is  in  inverse  ratio  to  its  racial  training  for  it.*® 

From  the  facts  cited  it  is  evident  that  diseases  like 
malaria,  which  are  newly  introduced  into  a  population  are 
epidemic  in  character,  and  therefore  virulent,  causing 
great  mortality.  They  become  endemic  in  the  course  of 
time  and,  while  not  responsible  for  many  deaths  directly, 
gradually  undermine  vitality  and  produce  degeneracy. 
It  is  necessary  now  to  prove  that  these  conditions  existed 
in  ancient  Greece. 

(4)   When  was  malaria  introduced  into  Greece,  or 

rather  Athens? 

Modern  Greece  is  exceedingly  malarious;  the  per- 
centage of  infected  persons  varies  from  almost  zero  in  a 
few  localities  to  almost  100  in  others;  in  the  Greek 
army  the  lowest  percentage  was  27.8  in  1902  and  the 
highest  44.8  in  1898  during  the  decade  1896  to  1905.'» 

"  Modern  Greece  is  Intensely  malarious.  In  the  Copaic  Plain, 
examined  by  me  last  year,  I  estimated  that  quite  half  the  children 


ffni 


?     , 


98        HEALTH  AND  SOCIAL  PROGRESS 


i 


' 


were  infected,  even  in  June  before  the  annual  malaria  season 
had  commenced.  The  Attic  Plain  is,  and  probably  always  was, 
much  healthier  owing  to  its  dry  cHmate;  but  numbers  of  other 
plains  and  valleys  are  certainly  as  bad  as  the  one  I  studied. 
The  Grecian  Anti-Malaria  League  has  collected  excellent  sta- 
tistics on  the  subject,  and  these  have  been  published  by  Drs. 
Savas,  Cardamitis,  and  others.  For  instance  it  has  been  esti- 
mated that  in  the  unhealthy  year  1905,  out  of  a  total  population 
of  only  about  two  and  a  half  millions,  nearly  a  miUion  people 
were  attacked  with  malaria,  and  nearly  six  thousand  died. 
Blackwater  fever,  the  worst  form  of  malaria,  is  exceedingly 
common.  I  have  never  seen,  even  in  India  and  Africa,  villages 
more  badly  infected  than  Moulki  and  Skipou  in  the  Copaic 
District.  The  Greek  Army  is  as  heavily  infected  as  was  the 
Indian  Army  until   the  last   few  years."  *<> 

The  malarious  character  of  modem  Greece  does  not, 
of  course,  prove  that  ancient  Greece  was  likewise  in- 
fected. Two  conditions  are  necessary  to  make  a  coun- 
try malarious,  the  presence  of  mosquitos  of  the  species 
anophelines,  and  the  existence  of  malarial  parasites  in 
human  beings.  Without  either  of  these  conditions 
malaria  is  impossible.  Sir  Patrick  Manson  describes  the 
introduction  of  this  disease  picturesquely. 

"  Imagine  an  island  in  mid-ocean,  far  away  from  any  malarial 
continent.  It  has  its  own  special  insect  pests,  mosquito  among 
them,  but  there  are  no  anopheles.  Malaria  therefore  is  un- 
known. On  an  evil  day  for  the  island  a  fast-steaming  ship 
arrives  and  introduces— perhaps  as  larva  in  a  water-tank,  or 
in  a  neglected  water-bottle  in  some  unoccupied  passenger  cabin, 
or  otherwise— the  cursed  insect.  The  hydraulic  and  climatic 
conditions  are  favorable  and  the  anopheles  multiply  apace. 
Presently  in  some  coolie  laborer  from  India  or  China,  or  in 
some  native  returned  from  service  in  a  foreign  country,  or  in 
a  sailor,  or  traveler,  malarial  gametes  come  on  the  scene.  The 
anopheles,  now  numerous,  become  infected,  the  inhabitants  get 
malaria,  and  the  island,  formerly  noted  for  its  salubrity,  becomes 
a  byword  for  unhealthiness. 


fi^F ' 


HEALTH  AND  ANCIENT  GREECE         99 

This  is  no  fancy  picture.  For  centuries  after  its  discovery 
and  colonization  Mauritius  was  noted  for  its  beauty,  its  de- 
lightful climate,  and  for  its  salubrity.  There  were  no  anopheles 
there  in  the  days  of  Paul  and  Virginia.  Situated  in  the  middle 
of  the  Indian  Ocean,  far  away  from  continental  influences, 
it  enjoyed  an  equable  climate  well  suited  to  recruit  the  broken- 
down,  anxmic  constitution  of  the  victim  of  tropical  disease. 
So  high  was  its  reputation  for  salubrity  that  up  to  the  early 
sixties,  in  times  when  Europe  was  not  so  accessible  as  it  is  at 
the  present  day,  it  was  used  as  a  sanitarium  by  the  British  in 
India.  Of  course  many  of  the  invalid  soldiers  and  civilians 
who  visited  the  island  and  many  of  the  imported  Indians  who 
labored  on  the  extensive  sugar  plantations  for  which  Mauritius 
was  famous,  must  have  introduced,  since  without  number,  mala- 
rial parasites.  In  those  happier  days,  there  being  no  anopheles 
present,  any  imported  parasites  did  not  spread,  they  died  out. 
But  about  the  time  I  mention,  that  is  to  say,  in  the  early  sixties, 
anopheles  were  introduced;  how,  is  not  known.  Gradually 
they  spread  over  the  island,  carrying  the  malarial  germ  with 
them.  A  big  epidemic  was  the  consequence,  and  now  malaria 
is  endemic  in  Mauritius,  and  large  areas  of  this  former  sani- 
tarium are  extremely  unhealthy. 

"  With  the  increasing  opportunities  of  these  modern  days  foi* 
rapid  travel  and  communication,  many  islands  and  isolated  dis- 
tricts at  present  healthy  will  at  no  distant  date  share  the  fate 
of  Mauritius  unless,  before  it  is  too  late,  effective  measures  are 
taken  to  prevent  the  introduction  of  anopheles."  *^ 

The  island  of  Mauritius  proves  that  a  definite  date  may 
be  fixed  for  the  introduction  of  this  disease ;  the  specific 
year  as  given  by  Major  Ross  is  1866."  Can  an  equally 
definite,  or  at  least  approximate,  date  be  given  for  the 
entrance  of  malaria  into  Attica?  Opinions  are  divided 
on  this  point.  Deaderick  seems  to  incline  toward  a  belief 
of  the  early  existence  of  the  disease  in  Greece."  Manson, 
too,  is  of  that  opinion,  since  "  The  history  of  malaria  goes 
back  to  times  of  remotest  antiquity.  Already  in  the  fifth 
century  B.C.,  Hippocrates  recognized  the  existence  of 
periodic  fevers,  and  divided  them  into  quotidian,  tertian. 


tt 


III 


1 


i 


Ill 


i^'l 


100       HEALTH  AND  SOCIAL  PROGRESS 

sub-tertian,  and  quartan.  Galen,  Celsus,  and  other 
Roman  writers  also  gave  accurate  descriptions  of  these 
fevers."**  Jones,  who  has  worked  particularly  on  this 
problem,  inclines  toward  the  introduction  of  malaria  into 
Athens  about  the  year  425  b.c.  But,  suppose  the  disease 
had  existed  from  early  times ;  that  would  not  necessarily 
prevent  good  health  of  the  Athenians,  since  the  cases 
might  be  few  and  mild  owing  to  particular  circumstances. 
Major  Ross  argues  this  point  as  follows : 

"Suppose  that  the  anophelines  have  been  present  from  the 
first,  but  that  the  number  of  infected  immigrants  has  been  few. 
Then,  possibly,  some  of  these  people  have  happened  to  take  up 
abode  in  places  where  the  mosquitos  are  rare,  others  may  have 
recovered  quickly;  others  may  not  have  chanced  to  possess 
parasites  in  suitable  stages  when  they  were  bitten.  Thus  the 
probability  of  their  spreading  the  infection  would  be  very  small. 
Or,  supposing  even  that  some  few  new  cases,  infections,  have 
been  caused,  yet  by  our  rough  calculations  in  section  12,  unless 
the  mosquitos  are  sufficiently  numerous  in  the  locality,  the  little 
epidemic  may  die  out  after  a  while  ...  for  instance,  during 
the  cold  season.  And,  if  the  number  of  infected  persons  intro- 
duced from  outside  remains  small,  this  state  of  things  may 
continue  for  years  or  centuries  .  .  .  the  disease  will  fail  to 
make  headway  and  will  die  out.  Now,  suppose  that  the  number 
of  infected  immigrants  is  suddenly  greatly  increased.  Then 
much  larger  numbers  of  mosquitos  will  become  infected,  and 
may  in  their  turn  infect  more  healthy  people  than  the  recovery 
rate  will  compensate  for.  Endemic  cases  will  begin,  will  in- 
crease; at  first  slowly,  then  rapidly,  until  suddenly  there  will 
be  a  widespread  epidemic."** 

Mr.  Jones  bases  his  argument  for  the  comparatively 
late  introduction  of  malaria  as  a  prevailing  disease  on 
four  facts.  L  The  absence  of  references  to  malaria  by 
non-medical  writers  prior  to  500  B.C.,  excepting  two 
doubtful  cases.  One  of  these  occurs  in  the  Iliad,  XXH. 
31  under  th^  name  of  "  f^ver,"  and  ma^  be  explained 


HEALTH  AND  ANCIENT  GREECE        101 

by  a  reference  to  the  coast  of   Asia   Minor.*'      The 
other    is    found    in    Theognis    (550  B.C.),    under    the 
name  of  "  ague."    This  may  refer  to  Megara,  where  the 
poet  lived  as  a  supporter  of  the  oligarchical  party,  or  to 
Asia  Minor.*^     H.  On  the  increasingly  frequent  refer- 
ences to  malaria  by  both  medical  and  non-medical  writers 
after  425  B.C.     The  first  of  these  is  made  by  Aristo- 
phanes in  the  Acharnians  (425  B.C.),  and  the  second  in 
his  Wasps  (422  b.c.).*®     Plato  in  the  Timceus  (between 
380-360    B.C.)    speaks    of    quotidian,    tertian,    and    the 
quartan    fevers.      Aristotle's    works    contain    numerous 
references  to  malarial  fevers.     Hippocrates  (born  about 
460  B.C.),  treats  of  malaria  both  in  the  Corpus,  and  in 
the  Airs,  Waters,  Places,  and  gives  the  division  of  malaria 
quoted  previously  by  Manson.    HL  The  introduction  of 
the  cult  of  /Esculapius  in  420  B.C.  at  Epidaurus,  which,  by 
the  way,  is  very  malarious  today,  having  in  some  parts 
nearly  100  per  cent  of  its  population  infected.*®    This  cer- 
tainly implies  that  ill-heahh  was  common.    The  suggestion 
that  it  was  caused  largely  by  malaria  is  strengthened  by 
the  frequency  with  which  the  votive  offerings  of  the 
Greeks,  after  illness,  took  the  form  of  a  representation  of 
the  abdomen,  since  the  malarial  spleen,  which  not  infre- 
quently reaches  the  weight  of   70  or  80  ounces,  over 
against  5  to  7  ounces  for  the  normal,  would  be  very 
noticeable,  and  the  consequent  enlargement  of  the  ab- 
domen would  certainly  make  a  great  impression  on  the 
non-medical  mind.*®    IV.  The  more  numerous  points  of 
contact  of  the  Athenians,  both  through  war  and  com- 
merce, with  other  nations.    They  undertook  the  disastrous 
expedition  into  Egypt — one  of  the  ancient  malaria  plague- 
spots — in  450  B.C.    During  the  first  Peloponnesian  War 
(431-404  B.C.)  their  armies  and  navies  were  to  be  found 
in  nearly  every  part  of  Greece  and  of  the  i^gean  Sea. 


>;    I 


102       HEALTH  AND  SOCIAL  PROGRESS 


Hn 


I 


In  425,  they  were  in  the  island  of  Sphacteria  which,  at 
least  at  present,  is  one  of  the  worst  malaria  centers  in 
the  Mediterranean.  From  415-413  they  were  at  Syra- 
cuse, where  this  disease  existed,  and  sickness  and  want 
caused  them  muCh  distress.  In  399  the  Ten  Thousand — 
reduced  to  8,000 — returned  after  their  march  through 
many  malaria  infected  parts  of  the  Persian  Empire.  The 
case  of  Mauritius,  cited  above,  illustrates  how  easily  this 
disease  may  be  introduced  into  a  hitherto  healthy  com- 
munity, although  the  contacts  with  the  outside  world 
were  not  nearly  as  varied  and  numerous  in  this  case  as 
those  of  Athens  during  these  fifty  years.  Hence  the  con- 
clusion that  malaria  was  introduced  into  Athens  during 
this  period  as  a  prevalent  disease,  seems  very  probable. 
Once  introduced,  it  would  have  its  baneful  effects. 
General  Gorgas  also  holds  that  Greece  was  free  from 
malaria  prior  to  500  B.C.  for  reasons  similar  to  those 
of  Mr.  Jones.* 

(5)  How  did  malaria  affect  the  Greeks? 

Under  the  first  question  a  number  of  injurious  effects 
from  malaria  were  cited ;  these  may  now  be  supplemented 
in  the  case  of  the  Greeks. 

"The  degradation  of  those  who  inhabit  malarious  places  was 
carefully  recorded  by  Hippocrates.  He  states  that  those  who 
live  in  low,  moist,  hot  districts,  and  drink  the  stagnant  water, 
of  necessity  suffer  from  enlarged  spleen.  They  are  stunted 
and  ill-shaped,  fleshy  and  dark,  bilious  rather  than  phlegmatic. 
Their  nature  is  to  be  cowardly  and  averse  to  hardship,  but  good 
discipline  can  improve  their  character  in  this  respect"*^ 

Plato,  in  the  TinuBus,  declares  "  that  the  humors  of 
acid  and  salt  phlegms,  and  such  as  are  bitter  and  bilious, 
when  no  outlet  for  them  from  the  body  can  be  found. 


*  The  Scientific  Monthly,  August,  1916,  p.  133, 
and  the  Prevention  of  Malarial  Fever." 


Ronald  Ross 


HEALTH  AND  ANCIENT  GREECE       103 


befog  the  soul  and  produce  manifold  vices — peevishness, 
melancholy,  rashness,  cowardice,  forgetfulness,  and  stu- 
pidity." " 

Jones  makes  this  statement  about  Greece  after  the 
fourth  century  before  Christ: 


«« 


Gradually  the  Greeks  lost  their  brilliance,  which  had  been 
as  the  bright  freshness  of  healthy  youth.  This  is  painfully 
obvious  in  their  literature,  if  not  in  other  forms  of  art.  Their 
initiative  vanished;  they  ceased  to  create  and  began  to  comment. 
Patriotism,  with  rare  exceptions,  became  an  empty  name,  for 
few  had  the  high  spirit  and  energy  to  translate  into  action 
man's  duty  to  the  state.  Vacillation,  indecision,  fitful  outbursts 
of  unhealthy  activity  followed  by  cowardly  depression,  selfish 
cruelty,  and  criminal  weakness,  are  characteristic  of  the  public 
life  of  Greece  from  the  struggle  with  Macedonia  to  the  final 
conquest  by  the  arms  of  Rome."** 

The  children  are  the  worst  sufferers  from  malaria  until 
at  least  the  age  of  adolescence,  when  they  become  partially 
immtme.  The  effect  which  these  repeated  attacks  of  an 
everlasting  and  ubiquitous  incubus  must  have  on  a  people 
is  well  described  by  Ellett. 

"  It  would  seem  that  this  disease  with  its  constant  drain  upon 
the  resources  of  the  growing  body,  must  put  a  check  upon  the 
development,  physical  and  mental,  of  each  successive  rising 
generation.  Viewed  from  an  entirely  medical  standpoint,  the 
question  can  admit  of  no  doubt.  The  succession  of  febrile 
attacks  would  alone  be  a  serious  tax  upon  the  growing  child; 
while  the  consequent  anaemia,  which  so  soon  makes  its  appear- 
ance, must  make  the  child  incapable  of  prolonged  application, 
and  rob  him  to  a  large  extent  of  his  powers  of  mental  recep- 
tivity. It  is  only  too  evident  that  in  a  few  generations  a  type 
of  man  possessing  extraordinary  mental  and  physical  powers, 
may  become  under  this  scourge  of  malaria  greatly  altered  and 
debased.  If  it  be  that  the  malarial  parasite  was  introduced 
into  Greece  during  the  fifth  century  b.c,  it  is  quite  possible 
for  the  disease,  running  a  practically  unchecked  course,  to  have 


« 


li 

I 


104       HEALTH  AND  SOCIAL  PROGRESS 

produced    the   profound    deterioration    which    occurred    in   the 
Greek  character  during  the  next  century  and  a  half."** 

(6)  Why  were  the  effects  so  disastrous? 
The  pernicious  effects  of  a  newly  introduced  disease 
have  been  explained  previously  under  the  third  question. 
In  the  case  of  the  Greeks  there  were  special  and  addi- 
tional reasons  why  malaria  should  assume  such  a  virulent 
character.     The  great  plague  of  429-427  b.c.  was  an 
indication  that  sanitary  measures  in  Athens  were  inade- 
quate.   These  conditions  were  favorable  for  the  breeding 
of  mosquitos,  and  all  that  was  needed  was  a  number  of 
infected  persons  coming  from  infected  regions  to  spread 
the  disease  rapidly.    During  the  Peloponnesian  War,  At- 
tica was  invaded  and  laid  waste  almost  constantly,  and  the 
country-people  had  to  take  refuge  in  the  city ;  food  had 
to  be  imported  from  abroad.    These  facts  brought  about 
a  crowding  of  the  population,  and  a  few  infected  persons 
would  suffice  to  spread  malaria  quickly.    This  was  espe- 
cially the  case  during  the  latter  part  of  the  war,  when  the 
Spartans  had  permanently  occupied  Decelea  in  413  b.c, 
and  the  country  people  had  to  live  not  only  in  the  Piraeus 
where  they  were  constantly  subjected  to  new  infections, 
but  between  the  long  walls.    The  food  supply  must  often 
have  been  scanty,  and  this  may  have  been  a  predisposing 
factor  to  cause  a  greater  virulence  of  the  disease,  since 
the  power  of  resistance  would  be  less. 

Another  factor  was  the  absence  of  a  specific.  Cinchona 
is  absolutely  necessary  in  the  treatment  of  malaria ;  and 
this  was  introduced  into  Europe  in  1640.  It  was  prized 
very  highly,  since  Louis  XIV,  who  was  attacked  with  a 
rebellious  and  severe  intermittent  malarial  fever  in  1679 
and  cured  by  Talbot  with  a  concentrated  vinous  tincture 
of  the  bark,  paid  48,000  pounds  sterling  for  the  secret  and 
gave  a  life  annuity  of  2,000  pounds  to  Talbot." 


HEALTH  AND  ANCIENT  GREECE        105 

The  Greek  peasant  of  today  values  quinine  almost  as 
much  as  his  bread,  and  the  government  has  formed  a 
monopoly  to  insure  its  purity  at  a  moderate  price.*^* 

Without  this  specific  the  ancient  Athenians  had  but 
little  chance  to  combat  the  disease,  since  they  did  not 
apply  the  only  other  possible  remedy— the  draining  of 
swamps  and  the  elimination  of  small  pools— sufficiently, 
because  they,  while  being  aware  in  a  general  way  of  the 
relation  between  malaria  and  swamps,  had  no  idea  of  the 
role  of  the  mosquito  in  the  transmission  of  the  disease. 
Hence  they  were  not  only  in  both  these  respects  handi- 
capped, but  also  unable  even  to  know  what  to  do  to 
fight  the  disease  effectively. 


_^^  ^. 


I 


HEALTH  AND  ANCIENT  ROME 


107 


I 


CHAPTER  VII 

HEALTH  AND  ANCIENT  ROME 

It  is  not  as  easy  to  fix  the  date  of  the  introduction  of 
malaria  into  Rome  as  it  was  in  the  case  of  Athens. 
Jones"  gives  the  second  Punic  War  (218-204  b.c.)  as 
a  possible  date.  Thomas  Ashby,  the  Director  of  the 
British  School  of  Archaeology  at  Rome  seems  inclined  to 
an  earlier  date. 

"What  had  previously,  it  seems,  been  a  well-peopled  region, 
with  peasant  proprietors,  kept  heahhy  by  careful  drainage, 
became  in  the  fourth  and  third  centuries  b.c.  a  district  consist- 
ing in  large  measure  of  huge  estates  (latifundia)  owned  by  the 
Roman  aristocracy,  cultivated  by  gangs  of  slaves.  This  led  to 
the  disappearance  of  the  agricultural  population,  to  a  decline  in 
public  safety,  and  to  the  spread  of  malaria  in  many  parts; 
indeed  it  is  quite  possible  that  it  was  not  introduced  into  Latium 
before  the  fourth  century  b.c.  The  evil  increased  in  the  later 
period  of  the  Republic,  and  many  of  the  old  towns  of  Latium 
sunk  into  a  very  decayed  condition  .  .  .  Cicero  speaks  of 
Gabii  and  Fidenae  as  mere  'deserted  villages,'  and  Strabo  as 
*once  fortified  towns,  but  n6w  villages,  belonging  to  private 
individuals.'  Many  of  the  smaller  places  mentioned  in  the  list 
of  Dionysius,  or  the  early  wars  of  the  Romans,  had  altogether 
ceased  to  exist,  but  the  statement  of  Pliny  that  fifty-three  com- 
munities ipopuH)  had  thus  perished  within  the  boundaries  of 
Old  Latium  is  perhaps  exaggerated.  By  the  end  of  the  Re- 
public a  good  many  parts  of  Latium  were  infected,  and  Rome 
itself  was  highly  malarious  in  the  warm  months."  ** 

Evidence  from  contemporary  writers  is,  however,  suf- 
ficiently plain  to  make  the  existence  of  malaria  cerUin. 

io6 


Plautus  (died  184  b.c.)  in  the  Curculio  refers  to  it  with 
the  question :  Did  a  fever  leave  you  yesterday  or  the  day 
before?  And  Terence  (died  159  b.c.)  refers  to  quo- 
tidian fever  in  the  Hecyra.  M.  Porcius  Cato  (died  149 
B.C.)  has  left  a  treatise  "  on  agriculture  "  and  speaks  in 
Chapter  CLVII  of  what  to  do  "  In  cases  of  black  bile 
and  swollen  spleen."  The  conjunction  of  black  bile  and 
enlarged  spleen  are  fairly  clear  symptoms  of  malarial 
cachexia. 

"From  Cato  to  Cicero  (106-43  b.c.)  is  a  long  interval,  and 
one  which  has  left  us  but  a  few  fragments  of  literature.  It 
may,  however,  be  noticed  that  Q.  Fabius  Maximus,  who  was 
consul  in  ac.  121,  suffered  from  malaria,  if  we  may  trust  the 
story  told  by  the  Elder  Pliny.  But  in  Cicero  is  found  frequent 
mention  of  tertians  and  quartans,  and  his  contemporary,  Varro 
(118-29  B.C.)  declares  that  in  marshy  places  'crescunt  animalia 
quaedam  minuta,  quae  non  possunt  oculi  consequi,'  and  that 
these  minute  creatures,  entering  the  body  by  the  mouth  and 
nostrils,  produce  'difficiles  morbos.'  From  the  time  of  Cicero 
most  writers  mention  malaria  in  unmistakable  language,  and 
it  certainly  had  become,  by  the  Christian  Era,  a  disease  with 
which  the  Romans  were  perfectly  familiar.  The  physician 
Celsus  (about  50  a.d.)  almost  confines  his  discussion  of  fevers 
to  the  intermittents,  so  that  in  his  book,  febris  is  practically 
equivalent  to  malaria."** 

The  prevalence  as  well  as  the  existence  of  malaria  in 
ancient  Latium  is,  then,  an  indubitable  fact.  Even  if  it 
existed  there  prior  to  2(X)  B.C.,  there  are  many  features 
in  Roman  history,  which  point  to  an  accentuation  of  the 
disease  after  that  time.  Rome  commenced  her  permanent 
expansion  beyond  the  borders  of  Italy  with  the  second 
Punic  War;  she  sent  her  armies  into  Africa,  Carthage, 
Egypt,  and  various  parts  of  Asia,  and  occupied  Greece 
and  Sicily.  But  all  these  countries  were  malarious; 
some  of  them  were  badly  infected.    The  armies  would 


!■   ■!(: 


1>A 


f 


i 


108       HEALTH  AND  SOCIAL  PROGRESS 


return  home  with  the  disease,  spread  it,  and  in  a  short 
time  it  would  become  endemic.  The  prisoners,  too,  com- 
ing from  many  infested  districts,  would  help  in  spreading 
the  disease,  especially  in  the  country  districts  where  many 
of  them  went  as  slaves.  It  was,  perhaps,  in  this  manner 
that  the  large  estates  of  the  Roman  gentry  became  so 
thoroughly  infected  that  many  parts  of  Latium  became 
uninhabitable. 

Economic  and  political  causes  assisted  in  the  spread 
of  malaria.  The  creation  of  the  large  estates  brought 
many  small  landowners  to  Rome,  where  they  helped  in 
increasing  the  ranks  of  the  plebeians.  The  result  was 
that  the  city  became  constantly  more  congested,  and  the 
country  districts  depopulated.  The  colonists  who  were 
sent  out  into  the  newly  conquered  provinces  were  the 
more  energetic  and  enterprising  farmers,  and  that  de- 
prived the  country  districts  of  the  best  elements.  The 
remainder  went  to  the  city  and  increased  the  rabble  in  the 
metropolis.  Without  occupation  and  without  regular  means 
of  support,  these  malaria-stricken  people  sank  lower  and 
lower  still ;  they  became  the  followers  of  every  demagogue 
who  promised  pattern  et  circenses,  or  rich  booty  from 
the  slaughter  of  the  patricians  and  the  conquered  peoples. 
In  the  course  of  time  the  upper  classes  were  infected,  and 
a  general  deterioration  of  Roman  character  commenced. 

A  debased  vitality  is  the  only  explanation  of  the  atroci- 
ties of  the  continuous  civil  wars,  of  the  butchering  of 
conquered  peoples  during  the  first  century  B.C.,  the 
crucifixion  of  slaves  for  seeking  even  a  semblance  of 
human  rights,  and  the  shamelessness  of  the  women  at 
and  around  the  court  of  the  first  emperors. 


"  Every  now  and  then  the  modem  world  is  shocked  by  atroci- 
ties committed  by  white  men  in  tropical  regions.    Humanity  and 


HEALTH  AND  ANCIENT  ROME 


109 


justice  seem  to  be  forgotten;  civilization  and  education  are 
powerless  to  prevent  furious  outbursts  of  savagery.  How  much 
of  this  is  due  to  the  baneful  influence  of  malaria  is  known 
only  to  those  who  have  an  intimate  acquaintance  with  the  disease. 
Something  of  the  same  kind  happened  in  Rome.  Malaria  made 
the  Greek  weak  and  inefficient;  it  turned  the  sterner  Roman 
into  a  bloodthirsty  brute.  The  terrible  pictures  of  life  in  the 
first  century  a.d.,  as  painted  by  Tacitus  and  Juvenal,  show  that 
Roman  society  was  not  only  wicked  but  diseased.  The  extrava- 
gant cruelty,  the  wild  desire  for  excitement,  the  absence  of 
soberness  and  self-control,  all  point  clearly  to  the  same  physical 
defect."  •» 

A  change  in  the  fundamental  characteristics  of  a  people 
is  much  more  serious  than  any  other,  and  such  a  change 
is  exactly  what  malaria  will  produce.  Just  because  it  is  a 
disease  only  occasionally  fatal  when  endemic,  it  is  neg- 
lected, and  exerts  its  harmful  effects  insidiously  upon 
many  individuals,  and  through  them  upon  the  life  of 
society  and  of  future  generations  by  reason  of  poor 
heredity  through  lowered  vitality.  Continued  through  a 
number  of  generations,  this  process  must  bring  about  ex- 
tinction. A  disease  of  this  kind  slowly  saps  the  energy 
and  vitality  of  a  people,  until  there  are  none  left  to 
continue  the  struggle.  For  while  other  diseases,  like  the 
plague  or  acute  attacks  on  single  organs,  brace  a  people 
by  weeding  out  the  unfit,  a  slow  disease  like  malaria 
seizes  all,  fit  and  unfit  alike,  until  a  greatly  depleted 
vitality  must  end  in  extermination. 

Note:  Just  as  this  manuscript  was  going  into  the  printer's 
hand,  a  new  book  by  Ellsworth  Huntington,  World  Power  and 
Evolution  (New  Haven,  1919).  appeared.  While  its  author 
tries  to  establish  the  climatic  theory— to  be  discussed  m  Chap- 
ter X — as  the  chief  cause  of  the  rise  and  fall  of  nations,  ho 
admits  on  pages  200  and  201  that  malaria  was  a  serious  con- 
tributory factor  in  the  change  of  the  Roman  character,  accept- 
ing the  theory  first  propounded  by  W.  H.  S.  Jones.  It  is  of 
interest  to  notice  that  he  places  the  climatic  change  which  started 
ti)«  dedin«  of  Rome  at  »bout  22$  bx.,  which  would  coincide 


fi 


no       HEALTH  AND  SOCIAL  PROGRESS 

with  Dr.   Ashby's  date  and  precede  that   of   Jones  by  seven 
years. 

In  discussing  the  backwardness  of  Turkey  he  likewise  admits 
the  importance  of  malaria  as  a  cause  and  suggests  the  elimina- 
tion of  it  as  a  remedy  (pp.  223-6).  This  seems  to  be  incon- 
sistent with  the  climatic  theory  as  the  chief  cause  since  climate 
is  beyond  our  control,  while  malaria  is  not. 


i^HW 


CHAPTER  VIII 

EFFECTS  OF  ILL  HEALTH  ON  THE  CLASSICAL 

WORLD 

The  effects  upon  the  classical  world  of  this  sapping  of 
vitality  are  fairly  clear,  even  though  the  argument  be  not 
strictly  conclusive  in  every  respect.  There  were  certainly 
other  factors  which  contributed  to  the  downfall  of  Greece 
and  Rome.  These  were,  however,  secondary  rather  than 
primary.  For  as  long  as  a  people  preserves  its  vitality 
and  abounds  in  health,  it  will  not  accept  its  doom  at  the 
hands  of  others  without  an  attempt  at  resistance.  It  is 
the  sick  man  who  resigns  himself  to  his  fate ;  it  is  the  de- 
feated party  that  invents  a  theory  to  account  for  the 
result.  The  well  man  will  struggle  to  preserve  his  ideals 
and  his  individual  and  political  identity ;  he  will,  if  he 
philosophizes  at  all,  think  out  a  course  of  action  to  de- 
flect the  blow  and  to  avert  the  evil,  and,  perhaps,  later, 
return  thanks  to  the  gods  for  his  deliverance. 

It  is  only  on  the  basis  of  a  greatly  depleted  vitality 
and  of  greatly  diminished  numbers,  that  we  can  explain 
the  attitude  of  the  Greeks  toward  their  misfortunes.  To 
take  up  the  last  point  first. 

The  internecine  conflicts  of  the  Greek  communities, 
the  deadly  struggles  of  the  various  factions  in  the  ma- 
jority of  the  cities,  and  the  numerous  wars  with  foreign 
powers,  had  obliterated  vast  numbers  of  the  old  race  of 
free  citizens  by  the  beginning  of  the  Roman  period.  The 
extermination  of  the  Plataeans  by  the  Spartans  and  of  the 
Melians  by  the  Athenians  during  the  Peloponnesian  War, 

III 


ill 


m 


I 


112       HEALTH  AND  SOCIAL  PROGRESS 

the  proscription  of  Athenian  citizens  after  the  war  and 
the  massacre  of  the  Corcyraean  oligarchs  by  the  demo- 
cratic party,  the  slaughter  of  the  Theban^  by  Alexander 
and  of  the  Corinthians  by  Mummius,  are  only  a  few  of 
the  more  familiar  instances  of  the  catastrophes  which 
overtook  the  civic  element  in  the  Greek  cities.     Just 
how  greatly  the  free  citizens  had  diminished  in  numbers 
by  the  close  of  the  first  century  after  Christ,  may  be 
judged  from  the  estimate  of  Plutarch  that  all  Greece 
could  not  furnish  more  than  3,000  hoplites.    All  this  must 
be  admitted ;  it  is  nevertheless  not  the  true,  at  least,  not 
the  full  explanation.    The  strife  of  factions  in  cities  and 
internecine  wars  had  existed  before,  and  been  perhaps 
more  sanguinary,  if  we  may  judge  from  the  razing  of 
conquered  cities ;  yet  the  number  of  free  citizens  did  not 
diminish,  but  rather  increased  from  the  time  of  Homer 
to  that  of  Pericles,  if  comparisons  of  military  strength 
are  to  be  trusted.    Homer  credits  the  united  Greek  forces 
with  100,000  men;  in  415  B.C.,  the  Atheniani  alone  were 
able  to  send — after  losing,  according  to  Grote,  4,400 
hoplites  in  the  plague  of  430  B.C.,  and  after  sixteen 
years  of  almost  continuous  fighting  in  the  Peloponnesian 
War — 36,000  men,  including  5,100  hoplites  to  Syracuse, 
and  reenforce  this  army  with  5,000  hoplites  two  years 
later.    This  force  was  almost  completely  lost,  yet  Athens 
continued  the  struggle;  and  even  after  the  slaughter  of 
3,000  of  her  soldiers  by  Lysander  in  405,  she  resisted 
Sparta  for  another  six  months,  and  only  a  few  years  later 
Xenophon  had  no  difficulty  in  collecting  10,000  men  for 
an  expedition  into  Asia  at  the  invitation  of  Cyrus.    All 
these  losses  through  war  were  heavy,  but  they  are  not 
the  full  explanation  of  the  later  submissive  attitude  of 
the  Greeks  toward  their  conquerors. 

We  must,  then,  look  for  another  cause  to  explain  the 


*i 


ILL  HEALTH  AND  THE  CLASSICAL  WORLD    113 


decay  of  Athens.  A  people  that  had  blended  the  ideals 
of  manhood  and  of  national  renown,  and  of  national 
and  personal  integrity;  that  had  produced  the  greatest 
number  of  famous  men  in  every  field  within  so  short  a 
time  with  such  a  small  population;  that  had  taught  the 
lessons  of  restraint  and  imbued  its  members  with  a  sense 
of  willingness  to  surrender  for  the  sake  of  these  ideals 
so  many  opportunities  and  pleasures,  according  to  the 
funeral  oration  of  Pericles — a  people,  in  short,  that  had 
conceived  a  clear  ideal  of  what  a  man  and  a  State  ought 
to  be  and  had  proved  its  validity  on  many  a  battlefield, 
must  have  been  healthy  both  physically  and  mentally. 
The  average  Athenian  was  joyous,  but  did  not  abandon 
himself  to  pleasure,  because  a  healthy  body  enabled  him 
to  keep  the  balance  which  his  philosophy  taught  him  to 
constitute  true  manhood.  This  man  knew  how  to  com- 
bine action  with  contemplation;  how  to  use  the  facts 
of  life  for  enriching  his  personality  and  becoming  a  more 
useful  citizen.  He  had  leisure,  but  he  used  it  for  the 
State  and  not  for  self-indulgence.  It  was  this  combina- 
tion of  a  proper  amount  of  action  and  contemplation,  or 
of  the  Dionysian  and  Apollonian  ideal  as  Nietzsche  called 
it — each  enriching  the  other — that  gave  the  Athenian  of 
Pericles*  age  the  self-control  and  harmony,  which  en- 
abled him  to  become  highly  efficient  in  all  lines  both  as  an 
individual  and  a  citizen. 

Yet,  but  a  hundred  years  later  the  "Philippics"  of 
Demosthenes  went  unheeded  by  the  Athenians  who  were 
justly  stigmatized  as  consisting  in  great  measure  of 
salaried  paupers.  They  talked  about  what  they  were 
going  to  do,  but  preferred  to  dwell  in  contemplation  of 
5ie  glory  of  their  ancestors.  Apollo  had  completely  re- 
placed Dionysius  in  the  aflFections  of  the  Greeks. 

Such  a  radical  change  could  not  have  taken  place 


i 


114      HEALTH  AND  SOCIAL  PROGRESS 

within  so  short  a  time  unless  for  physiological  reasons. 
The  policy  of  paying  small  salaries  to  the  citizens  to  en- 
able them  to  give  their  time  to  public  affairs,  may  have 
been  instrimiental  in  producing  a  deterioration  of  char- 
acter.   A  healthy  man  will,  however,  render  some  service 
for  such  salary.     The  very  fact  that  he  is  content  to 
take  something  without  rendering  a  quid  pro  quo  is  an 
indication  that  he  is  a  pauper— sl  physically  and  mentally 
diseased  person  who  has  lost  his  self-respect  and  is  con- 
tent to  live  on  the  labor  of  others.    It  is  evidently  a  case 
of  physical  degeneration.    How  was  that  brought  about? 
Major  Charles  E.  Woodruff  has  expounded  an  inter- 
esting theory  in  his  book  The  Effects  of  Tropical  Light 
on  White  Men.     It  is  briefly  stated  as  follows:  Every 
animal  and  race  of  men  has  a  zoological  zone,  in  which 
they  develop  and  prosper,  but  which  they  may  not  leave 
with  impunity.     The  actinic  or  short  rays  of  the  sun- 
light destroy  living  protoplasm ;  these  short  or  violet  rays 
are  more  numerous  in  strong  or  tropical  light ;  hence  skin 
pigmentation  was  evolved  for  the  purpose  of  excluding 
these  rays.    The  zoological  zone  of  the  blonde,  tall,  long- 
headed type  is  northwestern  Europe,  chiefly  Scandinavia, 
where  the  conditions  were  most  favorable  for  its  develop- 
ment— a  dark,  cold,  severe  climate.    Coldness  and  severity 
taxed  the  ingenuity  of  the  early  inhabitants  of  these  re- 
gions,  and  developed   brain-power;   the  darkness   and 
cloudiness  made   superfluous   the  development   of   pig- 
mentation.   This  highly  intellectual  people  is  responsible 
for  all  the  civilizations  from  India  to  England,  since  it 
spread  in  every  direction  owing  to  the  pressure  of  sus- 
tenance, and  became  the  ruling  class  everywhere  by  sub- 
jecting the  native  races.    But  they  could  not  survive  in 
lower  latitudes  owing  to  the  lack  of  pigmentation,  and 
died  out  before  they  could  acquire  it.    The  ideas  upon 


ILL  HEALTH  AND  THE  CLASSICAL  WORLD    115 

which  their  civilization  was  based,  survived,  however,  at 
least  for  a  time;  but  soon  became  mere  dead  formulae 
in  the  hands  of  the  darker  indigenous  peoples,  and  civili- 
zation decayed.  The  Greeks  and  the  Romans  were  both 
of  this  stock,  coming  from  the  north  at  different  times, 
and  creating  the  respective  civilizations  on  the  basis  of 
slavery.  They  were  unable  to  acquire  sufficient  pigmenta- 
tion and  became  literally  extinct,  since  the  modern  Greeks 
and  Italians  are,  according  to  Major  Woodruff,  the  de- 
scendants of  the  older,  brunette  type  of  man  which  was 
unable  even  to  continue  the  civilization  created  for  him 
by  his  fair-haired  and  blue-eyed  northern  masters. 

The  problem  of  Greek  and  Roman  degeneration  would, 
according  to  this  theory,  be  solved  by  complete  extinction, 
owing  to  inevitable  decay  out  of  one's  zoological  zone. 
It  would  take  too  much  time  to  criticise  this  theory  in 
detail.  Two  questions  only  need  be  asked.  Why  was  it, 
that  Scandinavia,  the  original  home  of  these  peoples,  was 
the  last  country  in  Europe  to  be  reached  by  modern 
civilization,  if  this  Scandinavian  or  Teutonic  type 
of  man  was  the  only  creative  genius  of  mankind  ?  Again : 
how  was  it  possible  for  this  hardy  race  to  survive  the 
southern  climate  for  at  least  a  thousand  years  in  Greece 
and  about  seven  hundred  years  in  Italy,  and  then  sud- 
denly collapse  within  a  century?  For  Major  Woodruff 
places  the  earliest  Teutonic  migration  about  2000  B.C., 
that  of  the  Dorians  about  1200  B.C.,"  and  that  of  the 
Romans  about  800  to  700  b.c.'^  That  both  people  de- 
generated rather  rapidly,  the  Greeks  after  400  b.c.  and 
the  Romans  after  200  B.C.,  seems  to  admit  of  little 
doubt  after  the  proofs  which  have  been  furnished.  Even 
admitting  Woodruff's  theory,  there  must  have  been  an- 
other cause  at  work  to  explain  the  rapidity  of  degenera- 
tion, or  perhaps  extinction. 


I 


•11 


1 


116       HEALTH  AND  SOCIAL  PROGRESS 

The  introduction  of  a  new  disease,  epidemic  at  first 
and  then  endemic,  which  gradually  undermined  the 
vitality  of  the  people,  seems  to  be  the  only  explanation. 
Malaria  has  that  effect  and  was  introduced  into  Athens 
about  75  years  before  the  decline  of  Greek  character  be- 
comes noticeable.  If  this  theory  is  accepted,  the  decline 
of  Greek  civilization  can  be  readily  explained. 

Greek  civilization  was  built  on  slavery.  There  was  the 
numerically  small  but  physically  and  mentally  strong  class 
of  free  Greeks,  who  devoted  themselves  to  intellectual 
and  warlike  pursuits,  and  were  of  a  superior  race.  This 
was  evident  from  the  fact  that  in  Sparta  the  ruling  class 
consisted  of  only  about  9,000  families  who  held  in  check 
and  exploited  the  Helots  numbering  about  200,000,  and 
drew  tribute  from  the  Perioeci  numbering  about  120,000. 
A  Spartan  must,  therefore,  as  a  fighter,  be  as  good  as 
ten  slaves.  In  Athens  we  have  a  similar  situation.  Dur- 
ing the  time  of  Pericles  there  were  in  Attica  about  90,000 
free-born  Athenians,  300,000  slaves,  and  40,000  Metics 
or  resident  foreigners  who  paid  for  the  privilege  of 
residence.  A  census  taken  in  309  b.c.  by  Demetrius  of 
Phalerum  gave  the  numbers  as  21,000  citizens,  10,000 
Metics,  and  400,000  slaves.*  The  significant  feature  in 
this  change  is  the  reduction  in  the  number  of  Metics. 
What  had  become  of  them  ?  Had  they  departed  with  the 
decline  of  Athens,  or  had  they  replaced  native  Athenians  ? 
The  latter  alternative  seems  the  more  probable,  because 
the  number  of  free  Athenians  had  not  changed  appre- 
ciably, since  21,000  citizens  in  309  b.c.  is  approximately 
equal  to  the  90,000  free-born  population  of  the  time  of 
Pericles.    The  explanation  may  be  found  in  the  fact  that 

♦The  number  of  slaves  cannot  be  ascertained  definitely,  since 
the  state  was  not  interested  in  them,  but  only  in  citizens  and 
taxpaying  Metics.  Henct  there  are  only  estimates,  which  run 
all  the  way  from  the  figures  given  to  as  low  as  180,000. 


ILL  HEALTH  AND  THE  CLASSICAL  WORLD    117. 

a  larger  number  of  Metics  had  received  citizenship  than 
was  provided  for  by  the  reforms  of  Cleisthenes  in  509 
B.C.  Owing  to  the  large  mortality  of  Athenians  in  war 
and  through  disease,  the  number  of  citizens  had  become 
very  small,  and  the  depleted  ranks  could  be  filled  only 
from  the  Metics  and  to  some  extent  from  the  slaves. 
That  means  a  considerable  change  in  the  constituency  of 
citizens,  although  it  need  not  surprise  those  who  are 
accustomed  to  similar  changes  in  New  York,  Boston, 
and  Chicago  through  immigration.  In  each  case  an 
older  population  was  supplanted  by  a  new,  and  in  the 
case  of  Athens,  by  an  inferior,  race.  Whereas  formerly 
citizenship  was  conferred  only  in  rare  cases  on  foreigners 
who  were  exceptional  individuals,  and  the  high  standard 
of  civic  efficiency  was  thus  maintained,  the  new  situation 
called  for  naturalization  on  a  large  scale.  The  question 
is  still  to  be  answered,  however,  why  the  ranks  of  the 
native  Athenians  were  depleted  and  not  those  of  the 
Metics  and  slaves.     Two  answers  should  be  given. 

The  citizens  were  drawn  into  military  service  and 
suffered  heavily  during  the  numerous  wars  as  has  been 
indicated  before.  The  Metics  and  slaves  suffered  hardly 
at  all  from  this  source.  The  more  important  factor  is, 
however,  that  which  concerns  disease.  The  Metics  were 
mostly  Asiatics,  and  the  slaves  were  mostly  Asiatics  or 
Africans  and  only  to  a  small  extent  of  Hellenic  origin. 
The  Asiatics  and  Africans  came  from  regions  where 
malaria  had  long  been  prevalent,  and  were  at  least  to 
some  extent  immune ;  they  suflFered,  consequently,  much 
less  from  this  disease  than  the  native  Athenians.  A 
disease,  as  explained  before,  always  causes  more  sickness 
and  greater  mortality  in  a  population  which  is  not  accus- 
tomed to  it.  This  is  well  illustrated  in  Mauritius,  where 
malaria  wa?  responsible  for  30,000  deaths  in  1867 — out 


•j^  T-y 


118       HEALTH  AND  SOCIAL  PROGRESS 

of  a  population  of  about  310,000  in  1861— -whereas 
cholera,  a  more  mortal  but  more  usual  disease  in  that 
island,  killed  only  17,000  persons  in  1854  in  a  slightly 
smaller  population.*'*  There  is  no  record,  of  course,  of  a 
similar  mortality  in  Athens,  but  the  ravages  of  malaria 
must  have  been  severe  and  the  ultimate  effects  far- 
reaching,  if  one  may  judge  from  what  is  known  about 
that  disease.  In  order  to  fill  up  the  depleted  ranks  of 
citizens,  Athens  became  less  discriminating  in  conferring 
citizenship  and  admitted  many  Metics  and  slaves  to  its 
rights.  The  citizens  of  the  time  of  Demosthenes  were, 
consequently,  a  largely  non-Hellenic  body ;  or,  if  Hellenic, 
so  weakened  by  malaria  that  they  had  lost  the  buoyancy 
and  confidence  which  were  such  marked  characteristics 
of  their  forbears. 

The  situation  about  the  third  century  B.C.  was,  con- 
sequently, very  different  from  that  of  the  end  of  the 
fifth.  The  citizens  of  Athens  consisted  largely  of  foreign, 
that  is,  of  inferior  stocks.  The  more  energetic  Greeks 
had  emigrated  to  other  parts  along  the  Mediterranean 
where  they  spread  their  culture.  It  is  remarkable  that 
so  many  Greeks  flocked  to  Alexandria  in  the  third  century 
and  that  this  city  became  famous  for  its  culture  in  so 
short  a  time.  An  explanation  may,  perhaps,  be  found  in 
the  fact  that  it  was  a  healthy  city  and  that  Greek  emi- 
grants found  here  a  climate  not  too  radically  different 
from  their  own.  For  Strabo  (63  B.C.  to  24  a.d.)  tells 
us  that,  notwithstanding  its  location,  it  was  free  from 
marsh-fever  even  in  his  time.**  The  radical  change  in  the 
character  of  the  population,  brought  about  by  disease, 
explains  to  a  large  extent  the  shallow  productions  of  the 
later  Greeks.  Menander  (342-291  B.C.)  wrote  not  only 
immoral,  but  stupid  and  insipid  plays.  "If  there  be  any 
moral  lesson  conve^^ed  by  the  picture  we  have  here  of 


ILL  HEALTH  AND  THE  CLASSICAL  WORLD    1 19 

Attic  society,  it  is  this:  that  the  slave  and  the  prostitute 
were  not  only  more  intelligent,  but  less  immoral  than  their 
masters."  •*  This  stricture  would  certainly  apply  more  to 
Asiatics,  such  as  the  Athenians  had  largely  become,  than 
to  the  descendants  of  the  victors  of  Marathon  and  Sala- 
mis.  The  Asiatics  were  the  fittest  to  survive  in  this 
particular  environment;  but  the  best  under  conditions 
of  this  kind  was  but  poor  material.  The  crab  apple 
lives  and  thrives  in  Siberia ;  it  is,  however,  a  poor  substi- 
tute for  the  luscious  pippin  of  the  Mohawk  valley  where 
the  climate  is  better.  The  more  serious  Greeks  were 
driven  into  anti-social  philosophies  at  home,  the  more 
active  men  into  mercenary  service  abroad,  while  the  most 
energetic  men  had  emigrated  to  Alexandria.  A  mob, 
recruited  partly  from  the  Metics  and  partly  from  the 
slaves,  ruled  Athens;  and  the  follies  and  violences  of 
stupid  and  corrupt  demagogues  were  directly  responsible 
for  the  disastrous  conquest  by  Mummius.  Small  wonder, 
that  this  new  type  of  Greeks  was  held  in  contempt  by 
the  Romans.  It  was  a  race  of  degenerates.  It  could  not 
produce,  so  it  began  to  comment.  It  could  not  originate, 
so  it  began  to  traffic  in  the  knowledge  of  Plato  and  the 
poetry  of  Homer.  The  homines  still  lived  but  the  znri 
were  dead. 

The  case  was  somewhat  different  with  the  Romans. 
They  have  always  been  more  coarse,  physically  and 
mentally.  Their  decline  was,  therefore,  less  rapid,  but 
not  less  certain.  An  important  feature  in  their  longer 
life  as  a  nation  was  the  larger  extent  of  their  country,  and 
the  consequent  greater  number  of  malaria-free  spots. 
Greece  has  even  today  some  of  these.  But  they  were 
of  no  help  to  the  Athenian,  since  he  could  not  leave  his 
own  little  City-State  without  trespassing  on  foreign  and 
hostile  ground.     Owing  to  the  size  of  his  country,  the 


m 


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HBBw 
1 1 1131 


120       HEALTH  AND  SOCIAL  PROGRESS 

Roman  could  go  north  and  south;  he  could,  in  any  case, 
go  into  the  mountains  and  escape  the  most  dangerous 
attacks  of  malaria.  Thus  the  custom  arose  among  the 
wealthy  Romans  of  having  villas  in  the  Apennines, 
whither  they  would  retreat  during  the  summer  and 
autumn.  This  was,  however,  only  a  temporary  relief  con- 
fined to  the  rich.  The  vast  majority  had  to  stay  in  the 
valleys  and  in  Rome,  where  the  air  was  not  only  hot  and 
humid,  but  full  of  mosquitos,  carrying  the  malaria  para- 
sites from  person  to  person.  The  infection  soon  produced 
its  effect  upon  the  Romans.  They  became  a  tainted  and 
debased  folk,  penned  up  within  the  walls  of  the  city.  The 
average  Roman  deteriorated  physically  to  such  an  extent, 
that,  as  Strabo  tells  us,  the  legions  had  to  be  recruited  from 
Liguria  because  of  the  massive  physique  of  these  people.*' 
When  these  were  infected  and  had  deteriorated,  the 
Romans  looked  beyond  the  borders  of  Italy,  and  Gauls, 
Spaniards,  Istrians,  and  Germans  were  enrolled  in  the 
legions.  A  number  of  prominent  men  of  letters  were 
foreigners;  during  the  first  century  a.d.,  there  were,  for 
instance,  four  Spaniards,  Lucan,  Martial,  Seneca,  and 
Quintilian.  The  foreign-bom  emperors  increased  in 
number.  This  new  blood  from  malaria-free  countries, 
was  infected  in  time,  and  every  new  infusion  shared  the 
same  fate,  till  the  Roman  Empire  fell  to  pieces.  Again, 
as  in  Greece,  there  were  other  factors;  but  this  disease 
was  the  original  reason  of  Roman  decay  and  gave  fuller 
scope  to  other  disintegrating  factors. — The  frequency 
with  which  German  conquerors  were  attacked  and  killed 
by  fevers  in  Italy  during  the  Middle  Ages  needs  merely 
to  be  mentioned  here  as  a  well-known  fact.  Time  and 
again  important  events  were  decided  by  an  attack  of  fever 
which  either  killed  or  caused  the  hasty  removal  of  the 
leader  to  Germany. 


ILL  HEALTH  AND  THE  CLASSICAL  WORLD    121 

The  final  result  was  that  the  builders  of  the  Roman 
Empire  either  died  out,  or  degenerated,  and  were  replaced 
by  foreigners.  In  subsequent  centuries  the  population 
grouped  itself  chiefly  with  respect  to  its  power  of  re- 
sistance to  malaria.  The  southern  parts  were  settled 
chiefly  by  the  Mediterranean  races  which  came  from 
regions  where  malaria  was  endemic,  and  who  were,  owing 
to  their  partial  immunity,  able  to  maintain  fair  health  in 
these  highly  infected  regions.  The  northern  parts— less 
infected — were  settled  chiefly  by  various  Alpine  races  and 
to  some  extent  by  the  Teutonic  race,  and  were  able  to 
maintain  good  health.  In  between  these  were  representa- 
tives of  both  races,  health  depending  partly  on  the  par- 
ticular locality,  and  partly  on  the  degree  of  civilization. 
The  point  which  these  facts  bring  out  is  the  necessity 
of  good  health,  especially  freedom  from  endemic  diseases, 
for  a  progressive  civilization.  In  the  north  of  Italy, 
certain  cities,  e.g.,  Turin,  Milan,  Genoa,  Venice,  Bologna, 
Florence,  and  Pisa,  have  for  centuries  stood  for  art, 
science,  literature,  advanced  agriculture,  and  manufac- 
ture. From  here  have  come  during  the  nineteenth  cen- 
tury, the  greatest  Italians — Cavour  from  Turin,  Gari- 
baldi from  Nice,  Mazzini  from  Genoa,  and  Victor  Em- 
manuel from  Savoy. 

Rome  owes  its  importance  largely  to  artificial  factors, 
historical,  administrative,  and  ecclesiastical ;  it  has,  how- 
ever, become  practically  free  from  malaria  owing  to 
better  drainage  and  sanitation,  and  to  more  efficient  medi- 
cal supervision.  Southern  Italy  is,  as  far  as  anything 
pertaining  to  progress  is  concerned,  practically  unknown. 
This  backwardness  may,  of  course,  be  due  to  racial 
factors.  If  so,  it  is  the  more  important  that  these  races 
should  be  liberated  from  the  endemic  diseases  which 
have  in  all  probability  made  them  v/hat  they  are. 


iii 


122       HEALTH  AND  SOCIAL  PROGRESS 


* 


The  Greeks  and  the  Romans  degenerated  through 
malaria.  H  more  highly  gifted  races  lose  their  creative 
power,  or  even  their  health  through  malaria,  it  is  evident, 
that  those  who  have  always  been  subjected  to  its  in- 
fluence, can  never  rise  to  the  full  power  of  either  of  those 
races.  It  is  impossible  that  a  race  whose  children  are 
infected  regularly  every  one  or  two  years  after  birth, 
and  are  subjected  to  the  drain  of  this  insidious  disease, 
its  long  succession  of  febrile  attacks  and  constantly  in- 
creasing anaemia,  should  develop  well-balanced  individ- 
uals. They  may  be  immune  to  malaria  after  adolescence, 
but  the  drain  on  the  growing  body  is,  as  a  rule,  too  heavy 
to  permit  of  full,  buoyant,  joyous  health,  which  is  needed 
for  higher  mental  pursuits.  A  weakness,  making  the 
nervous  system  highly  sensitive,  will  always  remain; 
persons  afflicted  in  this  way  may  become  very  receptive, 
but  they  cannot  become  creative  because  there  is  not  a 
sufficient  surplus  of  vitality  stored  up.  Only  those  who 
have  closely  watched  or  experienced  the  ravages  of 
malaria  can  possibly  know  the  lack  of  freedom  from 
which  the  patients  suffer.  They  vary  constantly  between 
elation  and  depression,  hence  are  always  under  the  sway 
of  physiological  conditions  and  emotions.  They  cannot 
be  self -controlled,  because  they  have  no  surplus  energy; 
hence  the  particular  feeling  always  controls,  whether  it  is 
elating  or  depressing.  It  could  indeed  hardly  be  other- 
wise. When  the  system  is  constantly  on  the  defensive, 
and  is  attempting,  so  to  say,  to  fill  in  a  bottomless  hole, 
it  cannot  develop  that  surplus  of  vitality,  so  necessary  for 
control  by  the  whole  organism.  The  chief  function  of 
such  a  system  must  be  to  stop  leakage,  and  that  means 
inability  to  develop  poise  and  balance.  In  Plato's  terms, 
the  particular  organs  claim  too  much  attention  in  propor- 
tion to  the  importance  of  their  function.     This  is  the 


ILL  HEALTH  AND  THE  CLASSICAL  WORLD    123 

chief  damage  which  malaria  and  other  low  fevers  inflict 
upon  the  race  and  the  individual,  and  consequently  upon 
civilization ;  since  races,  thus  handicapped,  can  never  be 
creative  or  progressive. 


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HEALTH  AND  THE  TROPICS 


125 


IkERI 


1^  ■■ 

I. 
•r 

i 

it 


CHAPTER  IX 

HEALTH  AND  THE  TROPICS 

After  viewing  the  eflFects  of  malaria,  particularly  on  the 
classical  world,  it  will  be  necessary  to  consider  another 
endemic  disease  in  a  larger  field, — hookworm  in  the 
tropics  and  sub-tropics.  This  will  enable  us  to  get  a  better 
idea  of  the  devastating  effects  of  such  a  disease,  since  we 
can  study  them  in  a  much  larger  field. 

The  tropics  have  always  been  unhealthy,  and  the 
Germans  have  succinctly  expressed  this  fact  in  the  state- 
ment :  "  Unter  Palmen  wandelt  niemand  ungestraf t." 
Formerly  these  unhealthy  conditions  were  attributed 
chiefly  to  the  heat  and,  more  recently,  to  the  actinic  rays 
of  the  sun.^^  Physicians,  studying  conditions  on  the  spot, 
have  found,  however,  that  endemic  diseases  are  chiefly 
responsible  for  the  unsanitary  character  of  the  tropics. 
The  hookworm  is,  in  addition  to  malaria,  one  of  these, 
and  its  discovery  is  one  of  the  most  important  events  not 
only  in  the  annals  of  medicine  but  in  the  world  at  large. 

The  hookworm  disease  (anchylostomiasis  or  unci- 
nariasis) has  been  definitely  known  as  to  symptoms  for 
three  centuries.  As  early  as  1648  Piso  spoke  about  it  in 
Brazil,  Father  Labat  in  Guadeloupe,  1748,  and  Bryon  Ed- 
wards in  Jamaica,  1799.  But  not  until  1838  were  the 
worms  foimd  by  Dubini  in  Milan  and  their  connection 
with  the  disease  suggested,  although  similar  worms  had 
been  found  in  the  badger  by  Goeze  in  1782  and  named 
hookworms  or  uncinaria  by  Froehlich  in  1789.  Since 
then  the  disease  has  been  extensively  studied  by  many 


physicians,  among  whom  may  be  mentioned  as  the  most 
prominent :  von  Siebold,  1845 ;  Bilharz  and  Griesinger  in 
Egypt,  1853;  Wucherer,  supported  by  Brazilian  physi- 
cians in  Bahia,  1866;  Paletti  and  Maliverria  in  Italy, 
1877-78,  also  Grassi  and  Parona,  1877.  In  America  the 
disease  was  referred  to  as  early  as  1808  by  Joseph  Pitt, 
and  by  J.  L.  Chabert  in  1821,  both  of  whom  described  the 
desire  for  dirt  eating  on  the  part  of  whites  and  blacks, 
although  neither  was  aware  of  the  hookworm.  In  1834 
Geddings  noticed  similar  symptoms  in  the  anaemic  and 
cachectic  "  sand-lappers  "  of  Carolina.  The  dirt  eaters 
of  Florida  were  described  by  Little  in  1845,  and  similar 
cases  in  Alabama  by  Sir  Charles  Lyall  in  1849.  James 
B.  Duncan  gave  a  fuller  description  of  cases  in  Louisiana 
in  1849.  None  of  these  men  were  aware  that  they  were 
dealing  with  an  extensive  disorder. 

In  1866  the  worms  were  noticed  by  Dr.  Joseph  Leidy 
who  thought  they  might  infect  man  and  cause  anaemia. 
In  1891  Dolley  called  the  attention  of  physicians  to  the 
fact  that  the  disease  was  prevalent  in  the  South,  and 
other  physicians  reported  several  cases  from  1894  to 
1901,  notably  Allen  J.  Smith  in  Galveston  who  studied 
the  ova  in  1901.  On  May  10,  1902,  Dr.  Charles  Wardell 
Stiles  discovered  a  new  species  of  the  worm,  Uncinaria 
Americana  or  Necator  Americanus.  Major  Bailey  R. 
Ashford  suspected  and  proved  the  disease  in  Porto  Rico 
in  November,  1899  and  published,  with  Dr.  Walter  W. 
King,  a  report  of  100  cases  in  American  Medicine,  Sept. 
5th  and  12th,  1903.  In  1904  a  government  commission 
was  appointed  for  the  study  and  treatment  of  the  disease 
in  Porto  Rico.  Meanwhile  Looss,  through  investigations 
carried  on  in  Cairo,  Egypt,  had  proved  in  1898  that  the 
larvae  penetrated  the  skin  of  human  beings,  and  thus 
pathology  and  treatment  were  made  much  easier.^^ 


I 


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126      HEALTH  AND  SOCIAL  PROGRESS 

The  range  of  this  disease  is  very  extensive.    The  in- 
fection is  rather  prevalent  in  a  zone  about  66  degrees 
wide,  extending  from  parallel  36  degrees  north  to  parallel 
30  degrees  south ;  it  occurs  less  frequently  in  higher  lati- 
tudes, the  extremes  being  51  degrees  north,  and  nearly 
40  degrees  south.    Practically  all  countries  lying  within 
the  zone  of  the  66  degrees  mentioned,  are  heavily  in- 
fected, while  north  and  south  of  it  cases  are  found  chiefly 
among  miners,  for  instance,  in  Hungary  where  95  per 
cent  of  them  were  infected,  or  in  Belgium  where  10,000 
miners  near  Liege  had  the  disease  in  1903.    The  Rocke- 
feller Sanitary   Commission   received   reports   from   54 
foreign  countries  stating  the  presence  of  the  disease ;  in 
Wales,   Germany,    Netherlands,    Belgium,   France,   and 
Spain,  it  is  confined  to  miners  and  is  found  in   few 
localities ;  but  in  46  countries  the  infection  is  general  and 
widespread.    The  more  important  of  these  countries  are : 
Egypt  with  about  90  per  cent  of  hospital  cases  in  Cairo 
due  to  hookworm  and  about  50  per  cent  general  infec- 
tion among  the  laboring  population ;  Algeria,  where  there 
is  a  considerable  amount,  although  the  percentage  is  un- 
known ;  and  along  the  east  and  the  west  coast  down  to 
the  Cape,  in  Uganda,  Mombasa,  Mozambique,  Zanzibar, 
Madagascar,  and  Mauritius.     In  Cameroon  70  per  cent 
of  the  population  are  infected.    In  the  interior.  Natal  and 
other  parts  are  seriously  infected,  although  figures  are 
not  available. 

Asia  has  many  seriously  infected  areas;  in  Ceylon 
about  90  per  cent  of  the  people  suffer  from  the  disease ;  in 
India,  between  60  and  80  per  cent  are  infected ;  in  China, 
the  infection  is  variously  estimated  from  25  per  cent  for 
the  city  population  to  75  per  cent  for  the  country  popula- 
tion. In  Cochin  China  the  disease  is  extremely  prevalent, 
and  in  the  Malay  states  at  least  60  per  cent  of  the  people 


HEALTH  AND  THE  TROPICS  127 

have  hookworm.     In  Korea,  about  70  per  cent  of  the 
farmers  and  50  per  cent  of  the  entire  population  suffer 
from  the  disease ;  in  Japan  cases  of  hookworm  are  fre- 
quent, but  of  a  mild  character.    Burmah,  Siam,  Borneo, 
and  Java  have  numerous  and  severe  cases ;  according  to 
some  estimates  the  percentage  in  Java  runs  as  high  as 
90  per  cent  in  some  localities.    In  the  Pacific  the  disease 
occurs  in  many  islands,  on  Samoa  70  per  cent  are  suffer- 
ing.    In  the  Straits  Settlements  about  10  per  cent,  and 
on  the  island  of  Sumatra  as  high  as  95  per  cent  have 
hookworm.     In  Australia  the  disease  is  found  chiefly 
in  the  Johnstone  River  district  of  Queensland,  where  in 
one  school  90  per  cent  of  the  children  were  infected. 

Going  over  to  South  America,  Argentina  has  but  few 
cases ;  in  Paraguay  they  become  more  numerous ;  and  in 
Brazil  hookworm  is  exceedingly  prevalent.  In  the 
Guianas  the  estimate  of  the  infected  is  about  50  per  cent 
of  the  population.  In  British  Honduras  the  percentage 
runs  as  high  as  70.  The  Central  American  republics  are 
severe  sufferers  from  the  disease— Panama,  for  instance, 
having  20  per  cent  of  infected  people.  Concerning 
Colombia,  the  Rockefeller  Commission  reports  as  follows : 

"  In  general,  it  may  be  stated  that,  with  the  exception  of  that 
portion  of  Colombia  situated  at  a  greater  altitude  than  3,000 
feet,  the  entire  country  is  infected  with  hookworm,  and  that 
within  the  infected  areas  about  90  per  cent  of  the  inhabitants  are 
victims  of  the  pest."  «» 

In  Mexico  the  disease  is  very  prevalent,  especially  in 
the  mining  districts. 

Coming  to  the  United  States  and  its  outlying  terri- 
tories, we  find  that  the  Philippine  Islands  are  seriously 
infected,  the  percentages  in  different  provinces  varying 
from  15  to  74  of  the  population.     Porto  Rico  with  a 


17 


128       HEALTH  AND  SOCIAL  PROGRESS 

population  of  about  one  million  in  1904  had  about  800,000 
cases,  while  among  the  workers  on  the  coffee  planta- 
tions, the  infection  runs  about  90  per  cent.     In  Con- 
tinental United  States,  all  the  states  from  Virginia  to 
Florida  and  Texas,  and  as  far  west  as  California,  are 
sufferers  from  this  disease,  particularly  Alabama,  Arkan- 
sas, Georgia,  Louisiana,  Mississippi,  North  and  South 
Carolina,  Tennessee,  and  Virginia ;  but  cases  are  found 
in  Kentucky,  and  other  states  along  the  Mississippi  River. 
The  46  foreign  countries  in  which  the  infection  is 
widespread,  comprise  14,464,158  square  miles,  with  919,- 
858,243  people.    To  this  should  be  added  1 1  of  our  own 
states  with  an  area  of  510,149  square  miles  and  a  popula- 
tion of  20,785,777.    This  means  that  about  940,000,000 
out  of   the   1,600,000,000  people  on  the  globe  live  in 
countries  where  hookworm  disease  is  prevalent.^*    These 
figures  are,  perhaps,  too  high;  but  even  if  they  should 
prove  to  be  somewhat  lower,  they  would,  nevertheless, 
be  sufficiently  high  to  act  as  a  serious  menace  to  the 
inhabitants  of  those  countries,  especially  since  in  most 
of  them,  malaria  is  likewise  very  prevalent.    These  people 
live  and  multiply,  but  they  lead  miserable  lives,  and  are 
unable  to  develop  high  vitality  and  fine  brains. 

The  physical  effects  of  hookworm  disease  are  both 
numerous  and  serious.  In  moderate  infections  a  lower- 
ing of  physical  and  mental  strength  occurs.  School  chil- 
dren are  seriously  retarded  by  the  disease,  and  are 
rarely  able  to  accomplish  more  than  60  per  cent  of  the 
required  work. 

"The  worst  cases  are  those  in  which  there  is  a  heavy  infec- 
tion. .  .  .  Even  well-to-do  subjects  become  severely  infected, 
but  among  the  underfed  the  results  are  most  serious.  Either 
the  patient  becomes  rapidly  anaemic  with  digestive  disorders, 
sometimes  severe  diarrhoea  with  hemorrhages,  anasarca  [dropsy ][ 


HEALTH  AND  THE  TROPICS 


129 


and  extreme  debility,  or  the  conditions  may  be  more  chronic. 
Indolence  and  weakness  lead  to  careless  habits,  reinfection 
occurs  from  time  to  time,  often  the  whole  family  becomes 
affected  more  or  less  seriously."  '^ 

Dr.  Charles  W.  Stiles  says: 

"The  injury  to  patients  results  from  the  following  factors, 
(l)  Sucking  of  blood  by  the  parasites,  which  is  a  constant 
drain  on  the  system;  (2)  Loss  of  blood  into  the  intestines 
through  the  minute  wounds  made  by  the  parasites,  the  factor 
which  also  tends  to  deplete  the  system;  (3)  The  wounds  form 
points  of  attack  for  bacteria,  hence  increase  of  the  chance  of 
bacterial  infection  as  well  as  toxic  infection  from  poorly  digested 
and  decomposed  food;  (4)  The  wall  of  the  duodenum  and 
jejunum  becomes  thickened  and  degenerated,  and  its  function 
is  thus  decidedly  interfered  with;  (5)  The  parasite  in  all  prob- 
ability produces  a  poisonous  substance  which  acts  upon  the 
patient."  " 

The  drain  upon  the  system  is  so  severe  in  many  in- 
stances that  in  cases  of  long  standing,  the  patient  is  un- 
developed physically  and  mentally.  Physical  growth  may 
be  retarded  to  such  an  extent  that  a  boy  or  girl  between 
the  ages  of  12  to  14  may  present  the  appearance  of  a 
child  6  to  8 ;  even  young  men  or  women  of  18  to  22  years 
old  may  have  the  development  of  children  from  12  to 
16  years ;  and  the  appearance  may  be  either  childlike  or 
senile,  especially  like  that  of  elderly  dwarfs.  The  re- 
productive powers  are  seriously  interfered  with  and  their 
development  is  very  much  delayed,  especially  in  the  case 

of  women. 

The  mental  effects  are  naturally  more  serious.     Dr. 

Ashf ord  says : 

"  Over  all  the  various  symptoms  with  which  the  unfortunate 
jibaro  (peon)  infected  by  uncinaria,  is  plagued,  hangs  a  pall  of 
drowsy  intellect,  of  a  mind  that  has  received  a  stunning  blow. 
There  is,  to  us,  no  one  symptom  at  once  so  characteristic  and 


i 


)' 


I      '1 


1^1 


130       HEALTH  AND  SOCIAL  PROGRESS 

so  pitiable.  A  benumbing  influence  seems  to  be  exerted  on  the 
mental  faculties,  even  before  anemia  and  heart  changes  arc 
noted.  There  is  a  hypochondriacal,  melancholy,  hopeless  ex- 
pression, which  in  severe  cases  deepens  to  apparent  dense  stu- 
pidity, with  indiflference  to  surroundings  and  lack  of  ambition."  »» 

In  some  cases  the  disease  leads  to  insanity ;  in  many, 
for  instance  in  Australia,  a  prevalent  craving  for  dirt 
eating  and  severe  moral  degeneration  is  reported.^* 

The  moral  effects  of  hookworm  disease  are  more  seri- 
ous still,  although  less  easily  pointed  out.     Not  much 
can  be  expected  of  a  people  whose  vitality  is  so  low 
that  it  averages  only  40  per  cent  of  hemoglobin  and  runs 
m  some  cases  as  low  as  8  per  cent,  whose  red  blood  cells 
number  less  than  2,000,000  in  many  cases,  and  in  a  few 
even  less  than  1,000,000,  instead  of  the  normal  5,000,000 
per  cubic  millimeter.    There  is  a  vicious  circle  of  disease, 
mefficiency,  and  poverty ;  a  lack  of  ambition  and  of  buoy- 
ancy.   The  patient  has  only  one  intense  desire— that  of 
deliverance.    Unable  to  help  himself,  he  turns  eagerly  to 
anyone  or  anything  promising  relief.    He  loses  his  feel- 
mg  of  independence  and  responsibility,  simply  because 
he  IS  unable  to  locate  and  cure  this  trouble,  and  his 
mind  is  filled  with  the  wildest  fancies.    Under  these  con- 
ditions he  falls  an  easy  prey  to  "  medicine  men,"  charla- 
tans, patent  cure-alls,  and  old  women  who  pose  as  medical 
oracles  and  whose  ignorance  is  exceeded  only  by  their 
temerity.     He  is  subject  to  all  kinds  of  superstitions— 
the   more   weird   and   grotesque,   the   more   acceptable. 
Witchcraft  and  voodooism  are  the  natural  product  of 
such  an  unregulated  imagination.     Lack  of  control  is  a 
characteristic  of  the  hookworm  victims,  and  any  stimulus 
from  within  or  without  is  acted  upon  unrestrainedly. 
Mentally  and  morally  he  rarely  passes  the  stage  of  the 
moron.    The  vegetative,  self-preservative,  and  reproduc- 


HEALTH  AND  THE  TROPICS 


131 


tive  fimctions  are  the  only  ones  which  have  any  interest 

for  him. 

The  economic  effects  are  more  readily  and  accurately 
gaged.  One  illustration  will,  perhaps,  best  serve  the 
purpose.  California  has  only  light  infections,  yet  Dr. 
Herbert  Gunn,  the  special  inspector  for  the  State  Board 
of  Health,  reports : 

"There  is  no  question  that  the  general  efficiency  of  the  men 
is  noticeably  impaired.     At  one  mine,  employing  about  300  la- 
borers, it  was  stated  that  a  reserve  of  about  25  men  had  to  be 
available  to  replace  those  who,  on  account  of  sickness,  did  not 
appear  for  work.    Quite  a  few  of  the  men  have  to  lay  off  every 
now  and  again  to  recuperate.    Several  who  were  unable  to  work 
stated  that  when  they  arrived  in  Jackson,  they  were  perfectly 
strong  and  well.    A  large  number  of  these  men  were  encountered 
on  the  streets,  some  of  them  presenting  marked   degrees   of 
anaemia.    The  greatest  loss  to  mine  operators  is  occasioned  by 
the  large  number  of  those  moderately  affected.   ...   A  loss 
of  20  per  cent  in  efficiency  of  those  infected  would  be  a  con- 
servative estimate.     That  would  mean  in  Mine  No.  2,  for  in- 
stance, where  over  300  men  are  employed  at  an  average  of  about 
$2.50  per  day,  and  estimating  the  number  of  those  infected  as 
low  as  50  per  cent,  a  loss  of  over  $20,000  a  year."  ^^ 

The  general  social  effects  of  the  disease  are  best  de- 
scribed by  Wickliffe  Rose,  the  Administrative  Secretary 
of  the  Rockefeller  Commission. 

"The  sharp  contrast  between  heavily  infected  communities 
and  communities  practically  free  from  infection  affords  the 
most  striking  illustration  that  I  have  seen  of  the  physical,  intel- 
lectual, moral,  social,  and  economic  results  of  hookworm  disease 

on  a  community. 

"  Such  a  contrast  we  saw  near  Dr.  Fisher's  home.  Lying  a 
few  miles  northeast  from  Emerton  in  Richmond  County  and 
extending  over  the  border  into  Northumberland  and  Westmore- 
land Counties  is  a  large  scope  of  country  which  for  generations 
has  been  inhabited  by  a  people  set  apart  by  marked  characteris- 


M 


ll 


132       HEALTH  AND  SOCIAL  PROGRESS 

tics  from  the  people  surrounding  them  on  every  side.  The 
people  are  called  '  Forkemites,'  .  .  .  and  for  generations  the 
name  has  been  a  byword.  Lack  of  energy  and  thrift  has  brought 
to  the  Forkemites  extreme  poverty  with  the  inevitable  mental 
and  moral  results."  ^« 

This  quotation  not  only  illustrates  what  havoc  the 
disease  may  work,  but  shows  that  it  alone  is  responsible 
for  such  results.  These  people  live  under  the  same 
climatic  conditions,  they  belong  to  the  same  stock  of 
Virginia,  and  are  of  the  same  faith  as  those  who  live 
nearby  but  are  more  fortunate  in  living  in  areas  com- 
paratively free  from  uncinariasis.  Just  as  in  the  case 
of  malaria,  so  in  that  of  this  disease  there  are  numerous 
"  islands  "  which  are  free  from  the  infection,  owing  to 
conditions  of  soil,  water,  and  sanitary  conditions  estab- 
lished by  the  inhabitants.  It  will  be  necessary  to  estab- 
lish this  point  a  little  more  firmly  by  details. 

Both  the  Rockefeller  Commission  and  the  Porto  Rican 
Commission  found  a  remarkable  improvement  in  the 
people  who  had  been  cured.  Dr.  Fisher  reports  one 
school  at  Totus  Key,  Va.,  where  38  out  of  40  children 
were  infected.  It  was  a  hard  school  and  could  not  keep 
its  teachers.  After  a  year's  treatment  the  children  had 
been  transformed— those  who  were  dull  and  listless  were 
active  and  alert;  and  those  who  could  not  study,  found 
joy  in  learning.  Coming  from  anaemic  parents,  they  were 
infected  in  infancy,  and  after  being  cured  their  cheeks 
showed  the  glow  of  health  for  the  first  time  in  their  lives. 
The  transformation  also  manifests  itself  by  a  new  light 
in  the  eye,  an  elastic  step,  and  a  hopeful  outlook  on  life. 
External  conditions  had  not  changed  with  these  children, 
excepting  that  a  few  sanitary  measures  had  been  intro- 
duced into  the  school  and  community;  the  victims  had 
b^en  cured  of  the  disease^  and  this  meant  a  tremendous 


HEALTH  AND  THE  TROPICS 


133 


change.  Or  when  we  read  of  case  after  case  in  which 
dull,  hopeless,  anaemic,  thriftless,  illiterate  people  have 
been  changed  into  bright,  alert,  active,  and  industrious 
persons  during  a  few  months— living  in  the  same  houses, 
on  the  same  farms,  without  any  changes  except  being 
cured  of  this  disease— we  must  come  to  the  conclusion 
that  the  only  drawback  from  which  they  suffered  was 
ill  health."  If  the  cases  were  not  well  attested  by  com- 
petent physicians  and  scientists,  one  would  imagine  that 
an  advertisement  of  "  a  patent  cure  "  was  being  read. 

These  rapid  changes  in  improvement  have  their  obverse 
in  rapid  deterioration.  The  report  of  Dr.  Gunn,  quoted 
previously,  states  that  several  of  the  sick  men  were  per- 
fectly strong  before  they  entered  the  infected  mines.  Dr. 
Dock  confirms  this  statement  from  his  own  observation. 

"If  we  were  to  select  the  strongest  people  in  the  country 
and  place  them  in  conditions  under  which  these  patients  are  now 
living  it  would  be  only  a  generation  or  two  before  even  a  race 
of  athletes  would  be  in  the  same  condition  as  the  people  under 
discussion."  '* 

We  have  here  cases  of  rapid  deterioration  analogous 
to  those  discussed  in  previous  chapters  (6,  7,  and  8)  as 
due  to  malaria;  and  these  cases  furnish  corroborative 
evidence  for  what  may  have  happened  to  the  Greeks 
and  Romans  after  the  introduction  of  malaria. 

In  order  to  prove  the  disastrous  effects  of  uncinariasis 
in  a  particular  country— as  we  showed  those  of  malaria 
in  Greece  and  Rome— it  may  be  best  to  select  Porto 
Rico  as  an  illustration,  because  the  disease  has  been 
studied  there  extensively  from  its  various  aspects.  The 
island  has  an  area  of  3,606  square  miles,  with  a  popula- 
tion of  about  1,120,000.  The  chief  products  are  sugar, 
tobacco,  coffee,  and  fruit.    There  is  litUe  manufacturing. 


i 


ii 


134       HEALTH  AND  SOCIAL  PROGRESS 

and  about  75  per  cent  of  the  labor  is  agricultural.  This 
means  that  the  welfare  of  the  whole  island  is  largely 
dependent  on  the  labor  capacity  of  those  engaged  in 
tilling  the  soil,  that  is,  on  the  health  of  the  jibaro  or 
peon.  Formerly  coffee  was  the  principal  crop,  having 
a  value  of  $7,492,453  in  American  gold  in  1897;  sugar 
in  that  year  was  valued  at  $2,456,898,  and  tobacco  at 
$732,117.  In  1910  the  values  had  changed  to  $23,545,922 
for  sugar,  $5,664,128  for  tobacco,  and  $5,669,602  for 
coffee.  During  the  years  1895-97  the  coffee  crop 
formed  70  per  cent  of  the  value  of  all  exports,  in  1910 
it  had  dropped  to  about  14.5  per  cent.  Whence  this 
change?  A  few  words  on  hookworm  disease  will  be 
sufficient  to  explain  it. 

The  disease  seems  to  have  been  introduced  from  Africa 
with  the  slaves  about  1530,  since  Columbus  reported  of 
the  original  inhabitants  that  they  possessed  fine  stature, 
and  were  "  people  of  beautiful  presence."  ^*  In  all  later 
reports  the  common  white  people  are  characterized  as 
lazy,  and  indifferent  to  all  improvements.  In  a  descrip- 
tion of  Porto  Rico  in  1834  we  read : 

"  Most  of  these  colonists  arc  inconceivably  lazy  and  indiffer- 
ent. Lying  back  in  their  hammocks,  the  entire  day  is  passed 
praying  or  smoking.  Their  children,  isolated  from  the  city, 
without  education,  live  in  social  equality  with  the  young  negroes 
of  both  sexes,  acquiring  perverted  customs,  only  later  to  become 
cruel  with  their  slaves."  «<* 

But  the  more  accurate  observers  state  that  these  people 
were  anaemic  with  a  dead  white,  yellow,  or  greenish  hue ; 
that  the  negroes  and  mestizos,  when  sick,  were  of  an 
ashen  gray  color.  These  descriptions  fit  those  suffering 
from  uncinariasis,  both  as  to  complexion  and  supposed 
moral  turpitude.    The  latter  was,  of  course,  nothing  but 


HEALTH  AND  THE  TROPICS 


135 


the  result  of  physical  lassitude  and  low  vitality,  owing 
either  to  hookworm,  malaria,  or  to  both.  Writers  of 
former  centuries  in  describing  the  whites  in  the  tropics 
and  sub-tropics  laid  the  blame  for  this  lassitude  on  moral 
grounds,  because  they  did  not  know  enough  about  the 
effects  of  endemic  diseases  upon  the  body.  Dr.  Ashford 
refutes  this  charge  in  these  words : 

"  We  cannot  believe  that  vicious  idleness  comes  natural  to  the 
Spanish  colonist,  even  in  the  tropics,  for  the  very  reason  that 
we  have  seen  these  descendants  at  their  very  worst,  after  the 
neglect  of  four  centuries  of  their  mother  country  and  after 
the  laborious  increase  of  an  ansemic  population  in  the  face  of  a 
deadly  disease,  whose  nature  was  neither  known  nor  studied, 
work  from  sunrise  to  sunset  and  seek  medical  attention,  not 
because  they  felt  sick,  but  because  they  could  no  longer  work."  *>^ 

These  men  were  sick  and  could  not  work,  and  this  fact 
explains  the  change  in  the  decline  of  coffee  values. 

Coffee  is  usually  planted  on  small  farms  on  the  hill- 
sides, and  requires  much  shade  and  moisture — ^thus  af- 
fording ideal  breeding-grounds  for  the  parasites  of  this 
disease.  Sugar,  on  the  other  hand,  requires  a  dry  soil, 
sun-baked,  and  bereft  of  shade— a  rather  poor  culture 
ground  for  hookworm.  After  the  American  occupation 
capitalists  opened  up  large  sugar  plantations  equipped 
with  modern  machinery,  paid  fair  wages,  provided  better 
housing  conditions,  and  introduced  various  sanitary 
measures  among  their  laborers,  who  were  chiefly  negroes 
and  relatively  immune  to  uncinariasis.  Under  these 
conditions  the  sugar  crop  increased  rapidly,  while  that 
of  coffee  decreased  because  the  laborers  were  not  so 
well  protected.  That  is,  however,  not  the  whole  story. 
The  coffee  planters  are  much  more  numerous,  and  are 
the  most  exposed  to  the  hookworm  disease.  Sugar  and 
tobacco  can  be  planted  only  in  the  coast  regions,  and  by 


136       HEALTH  AND  SOCIAL  PROGRESS 

far  the  larger  part  of  Porto  Rico  must  be  given  up  to 
coffee.  Thus  the  majority  of  the  population  is  exposed 
to  the  dangers  of  the  hookworm  disease. 

"The  picking   of   coffee   is   all   too    frequently   done   in   the 
pouring  rain,  for  the  harvest  coincides,  as  we  have  seen  before, 
with  the  wet  weather.    The  vast  majority  of  the  pickers  now] 
and  all  before  the  campaign  against  anaemia  began,  are  bare- 
footed.    They   work    from   a   little   after   dawn   to   near   dark, 
and  are  thus  employed  for  about  three  months,  the  number  of 
almudes  picked  getting  scarcer  as  the  ripened  berries  are  gath- 
ered in.     These  plantations  are  heavily   shaded,  indeed   doubly 
so,  for  the  coffee  bush,  itself  affording  a  dense  shade,  is  further 
shaded  by  light  guavas  or  trees  about  the  size  of  a  maple.    Here 
in  this  shade  the  sopping  wet  ground  is  befouled  by  the  multi- 
tude  of  sick  each   day,  and   the   ripening  ova  give   rise  to  an 
infinity  of  nests  of  active  larvae  into  which  several  days  there- 
after the  same  or  other  workers  must  tread.    The  result  is  that 
uncinariasis  has  its  great  breeding  place  in  the  coffee  plantations 
of  Porto  Rico,  and  here  a  barefooted  people  pollute  the  soil 
and  are  infected  and  reinfected  by  it  until  the  life  of  every 
man,  woman,  and  child  is  punctuated  by  a  vast  number  of  re- 
infections, casual  yet  common  in  the  nine  months  of  ordinary 
work,  certain   and  continuous  during  the  coffee  harvest  when 
no  worker  escapes  who  is  without  shoes.    Therefore  it  is  small 
wonder,    with   constantly   arriving   reinforcements    to   the    little 
army  of   parasites   that  thrive  at  the   expense  of  the  laborer, 
that  we  find  a  sick  workingman  in  the  country."  ** 

Previous  to  the  American  occupation  a  still  larger 
percentage  than  at  present  were  engaged  in  coffee  grow- 
ing, and  the  infection  was  correspondingly  more  preva- 
lent. How  much  this  disease  must  have  affected  the 
condition  of  the  Porto  Ricans  we  can  only  surmise  when 
we  read  that  "  It  cripples  industrial  effort,  limits  mental 
expansion,  weakens  the  body  and  depresses  the  spirit, 
until  many  laborers  in  a  country  where  agriculture  is  the 
chief  source  of  revenue,  are  enervated,  despondent,  with- 


HEALTH  AND  THE  TROPICS 


137 


out  hope  of  betterment,  and  without  the  power  to  save 
themselves.     Sometimes  a  man  cannot  earn  enough  to 
feed  his  family,  and  he  is  driven  to  eat  the  crudest  gifts 
of  a  bountiful  nature  in  the  wild  fruits  of  Porto  Rico."  ^' 
It  cuts  down  man,  woman,  and  child  of  every  age,  and 
causes  diminution  in  earning  capacity  of  50  per  cent  or 
even  more.    In  light  cases,  having  over  60  per  cent  hemo- 
globin, a  previously  vigorous  individual  finds  his  strength 
and   energy   waning,  becomes   dyspeptic,   disinclined   to 
work,  and  generally  "  run  down,"  and  has  a  faint  pallor. 
In  moderate  cases,  averaging  between  30  and  60  per  cent 
of  hemoglobin,  the  individual  becomes  anaemic,  with  low 
mental  and  physical   activity.     The   patient   looks  and 
feels  definitely  sick.     Mere  disinclination  to  work  has 
changed  to  partial  inability,  since  any  exertion  brings  on 
palpitation  of  the  heart,  and  sudden  changes  of  position 
cause  dizziness.    He  is  pale  and  half  narcotized.    In  in- 
tense  cases,   with   hemoglobin   below    30   per   cent,    the 
patient  has  dilation  of  the  heart,  extreme  pallor,  and  a 
fatal  termination  of  the  disease  may  occur  at  any  time. 
When  we  remember  that  the  population  of  this  island 
was  about  1,000,000  in  1904,  that  about  800,000  of  these 
were  estimated  to  be  infected,  and  that  the  infection 
wouli  run  as  high  as  90  per  cent  on  the  coffee  planta- 
tions, we  must  conclude  that  no  high  state  of  mental, 
moral,  and   social  conditions  was  possible   with  people 
who  suffered  from  a  disease,  the  symptoms  of  which  have 
just  been  described,  especially  if  we  find  that  about  30 
per  cent  of  the  cases  coming  under  the  observation  of 
physicians  were  "  intense,"  45  per  cent  "  moderate,"  and 
only  25  per  cent  "  light." 

Hookworm  is,  however,  not  the  only  curse  of  this 
island.  Porto  Rico  has  also  suffered  from  malaria.  No 
definite  figures  are  available  in  regard  to  this  disease,  as 


138       HEALTH  AND  SOCIAL  PROGRESS 

they  are  for  uncinariasis,  which  was  made  a  matter  of 
several  special  reports.  The  "  Report  of  the  Governor 
of  Porto  Rico  for  1913  "  contains,  however,  some  signifi- 
cant figures,  which  will  enable  us  to  draw  some  con- 
clusions in  regard  to  the  prevalence  of  malaria.  On  page 
113,  about  60  per  cent  of  all  deaths  are  listed  as  possibly 
due  to  malaria.  This  is  certainly  an  exaggeration,  since 
out  of  the  total  number  of  deaths,  (26,034  during  the 
fiscal  year  1913)  all  cases  of  diarrhoea  and  enteritis 
claimed  5,372,  tuberculosis  of  the  lungs  1,536,  hookworm 
1,347,  i.e.,  anchylostomiasis  383  and  anaemia  chlorosis  964, 
and  malaria  1,073.®*  This  comparatively  small  number  of 
deaths  does  not,  however,  argue  a  rare  occurrence  of 
malaria,  since  Colonel  Gorgas  explains  the  infrequency 
of  deaths  from  this  cause  as  perfectly  compatible  with  its 
prevalence.    He  says: 

"The  best  measure  of  the  working  efficiency  of  a  force,  as 
far  as  health  is  concerned,  is  the  daily  number  of  sick.  For 
instance,  in  a  force  such  as  we  have  at  present,  we  might  have 
1,500  cases  of  pneumonia,  which  would  average  ten  days  each 
in  hospital,  and  give  us  500  deaths.  Fifteen  hundred  cases  of 
malaria  would  average  seven  days  in  hospital,  and  give  us  not 
more  than  thirty  deaths.  The  deaths  from  malaria,  therefore, 
represent  a  very  much  larger  nonefficiency  from  disease  than 
do  the  deaths  from  pneumonia.  Two  deaths  from  malaria 
would  mean  that  100  men  had  been  sick  for  seven  days;  that 
is,  that  700  days  had  been  lost  from  malaria  during  the  year. 
Two  deaths  from  pneumonia  would  only  mean  that  6  men  had 
been  sick  for  ten  days,  and,  therefore,  represent  only  sixty  days 
lost  from  pneumonia."  ** 

The  1,073  deaths  attributed  to  malaria  would  on  this 
basis  represent  at  least  53,650  cases  of  seven  days*  dura- 
tion. This  is,  of  course,  too  low  a  figure,  since  Colonel 
Gorgas  argues  from  conditions  as  they  exist  in  the  Canal 
Zone  where  the  employees  are  carefully  watched  and 


HEALTH  AND  THE  TROPICS 


139 


instantly  taken  to  the  hospital  when  they  show  any  symp- 
toms of  disease.    In  the  larger  part  of  Porto  Rico,  that 
is  impossible,  owing  to  the  scarcity  of  properly  trained 
physicians ;  and  many  cases  of  malaria  are  not  diagnosed 
correctly   so  that  the   cases   linger  on   for   weeks   and 
months,  and  deaths  are  attributed  to  other  causes.     It 
seems  therefore  safe  at  least  to  double  the  number  of 
cases  of  malaria  in  this  island,  and  to  sextuple  the  number 
of  days  of  illness.    This  would  give  approximately  one 
malaria  case  in  ten  of  the  inhabitants,  and  a  loss  of  42 
working  days  per  patient.     That  would  give  us  with  a 
population  of  over  a  million  at  a  conservative  estimate 
100,000  cases  of  malaria  with  a  loss  of  4,200,000  working 
days   per   year.      The    small   number   of   deaths    from 
malaria  during  1913  is,  however,  only  a  part  of  those 
which  occurred  previous  to  the  sanitary  work  which 
was  inaugurated  after  the  American  occupation,  since 
very  little  was  done  in  a  scientific  way  to  combat  the 
disease.     Just  how  many  cases  there  were,  it  is  impos- 
sible even  to  estimate,  as,  due  to  the  illiteracy  of  80 
per  cent  of  the  people  and  to  the  scarcity  of  competent 
physicians,  no  accurate  records  could  be  kept.     That 
there  was  much  sickness  and  mortality  is  certain,  as  may 
be  shown  from  the  retardation  of  increase  in  the  popula- 
tion after  1765  to  1775,  when  the  decennial  rate  of  in- 
crease was  57  per  cent,  which  dropped  to  16  per  cent  in 
1887-89,  and  rose  only  to   17.3  per  cent  from   1899- 
1910,  notwithstanding  the  great  work  of  sanitation  and 
medical  supervision  introduced  by  the  government  during 
the  latter  part  of  this  period.    This  increase  has  taken 
place  in  the  face  of  a  very  high  death  rate  in  a  dense 
population— approximately  300  to  the  square  mile.    The 
year  1899  may  serve  as  an  example  of  these  high  rates, 
because  the  birth  rate  exceeded  a  death  rate  of  40  per 


140       HEALTH  AND  SOCIAL  PROGRESS 

1,000.  Another  fact  points  likewise  in  the  direction  of  a 
decreased  vitality.  The  population  of  this  island  below 
10  years  of  age  has  a  percentage  of  30.9,  a  greater  per- 
centage than  that  of  any  civilized  country,  e.g.,  22.2  per 
cent  in  the  United  States;  yet  in  the  latter  country  13.8 
per  cent  are  50  years  of  age  or  over,  against  9  per  cent 
in  Porto  Rico.  The  decreased  birth  rate  and  the  shorter 
span  of  life  point  toward  lowered  vitality — a  condition 
which  could  not  be  overcome  by  the  various  ameliora- 
tive and  preventive  efforts  of  the  government  in  a  few 
years.  The  enormous  number  of  deaths  from  tuberculo- 
sis and  from  diarrhoea,  as  well  as  the  13,441  deaths  from 
all  diseases  of  those  under  age  in  a  total  mortality  of 
26,034  merely  corroborates  this  statement,  since  low 
vitality  alone  can  explain  such  mortality.  Even  if  we 
should  take  the  lowest  estimate  of  300,000  for  those  who 
suffer  from  uncinariasis,  and  figure  only  100,000  for 
malaria  patients,  we  are  nevertheless  face  to  face  with  a 
serious  condition,  since  we  have  over  one-third  of  the 
population  ill  as  the  effect  of  two  diseases ;  the  other 
diseases  combined  would  add  at  least  17,  and  this  would 
make  at  least  50  per  cent  of  the  total  population  patients 
more  or  less  constantly  ill  as  against  about  4  per  cent  of 
permanent  sickness  in  the  United  States. 

The  relation  of  malaria  and  uncinariasis  is  interesting 
from  another  point  of  view.  The  former  attacks  princi- 
pally children  before  and  up  to  the  age  of  puberty,  and 
then  gradually  releases  its  hold ;  the  latter  attacks  chil- 
dren comparatively  seldom,  but  is  most  virulent  after 
puberty.  Out  of  a  total  of  29,219  patients  treated  for 
hookworm  in  1906-07  we  have  1.09  per  cent  less  than  5 
years  of  age;  8.90  per  cent  from  5  to  9;  20.80  per  cent 
from  10  to  14;  37.45  per  cent  from  15  to  29;  24.15  per 
cent  from  30  to  49;  7.49  per  cent  over  50."    It  seems, 


HEALTH  AND  THE  TROPICS  141 

therefore,  that  no  sooner  does  the  jibaro  get  over  the 
age  when  Scylla  threatens  his  life,  than  Charybdis  is 
almost  sure  to  attack  and  kill  him. 

In  this  brief  discussion  of  the  case  of  Porto  Rico 
stress  has  been  laid  on  hookworm  disease,  with  a  briet 
mention  of  malaria.    There  was  no  intention  of  claiming 
Xse  to  be  the  only  diseases  in  the  island,  but  simply 
the  endeavor  to  show  that  of  the  152  diseases  enumerated 
as  the  causes  of  one  or  more  deaths,  these  two  were 
responsible  for  a  high  percentage,  and  were  the  pre- 
disposing  cause  of  many  more  by  depleting  and  devitahz- 
ing  the  body.     Tuberculosis  of  the  lungs  and  diarrhoea 
with  enteritis  were  mentioned  as  the  cause  of  more  deaths 
than  malaria  and  uncinariasis;  neither  of  these  diseases, 
however,  kill  people  in  vigorous  health,  but  more  usually 
those  with  low  vitality.    Malaria  and  uncinariasis  under- 
mine  the  constitution,  and  thus  predispose  toward  other 
diseases.    They  are  responsible,  moreover,  for  that  low 
mentality,  small  initiative,  and  lack  of  ambition,  which 
are  reported  by  observers.    This  should  cause  sma  1  sur- 
prise  if  the  meaning  of  health  (see  chapter  two)  con- 
sists essentially  in  a  natural  and  irresistible  desire  for 
activity  owing  to  surplus  vitality.     Healthy  men  can 
strive,  plan,  devise  ways  and  means  to  improve  their 
condition;  ill  men  are  content  to  leave  things  as  they  are, 
because  they  have  no  energy  to  spare  for  the  new  exer- 
tion  required  for  experiments.     Their  principal  desire 
is  for  relief ;  and  the  whole  attitude  of  mind  becomes 
plaintive,  passive,  and  negative.   The  inevitable  result  is  a 
static  civilization. 


CHAPTER  X 

HEALTH  AND  WORLIXPROGRESS 

The  facts  brought  out  in  the  last  chapter  have  a  signifi- 
cance which  cannot  be  over-estimated.  For  what  is  true 
concerning  Porto  Rico  applies  to  the  tropics  and  sub- 
tropics,  and,  if  malaria  be  included,  to  a  very  much  wider 
area — indeed  to  the  larger  part  of  the  temperate  zone. 
If  the  facts  as  to  disease  and  its  bearings  have  been  cor- 
rectly explained,  they  ought  to  elucidate  conditions  as  to 
progress  in  the  past,  and  to  throw  some  light  on  the 
future  movements  of  mankind.  An  attempt  will  be  made 
in  this  chapter  to  explain  some  of  these  problems. 

I.    THEORIES    ADVANCED   TO    ACCOUNT    FOR    PROGRESS 

Explanations  of  the  progress  of  man  from  the  stage 
of  his  primitive  ancestors  may  be  roughly  divided  into  five 
classes. 

1,  the  transcendental;  2,  the  historical  or  accidental; 
3,  the  natural  or  geographical;  4,  the  anthropological; 
5,  the  actinic  ray  theory  of  Major  Woodruff. 

1.  The  transcendental  theories  of  various  kinds,  e.g., 
the  mythological,  theological,  and  philosophical,  which 
have  determined  the  thinking  of  past  ages  until  recent 
times,  are,  of  course,  unscientific.  The  philosophy  which 
looked  upon  Cyrus  the  Great  as  the  executive  of  Jehovah 
to  punish  disobedient  people,  is  no  more  taken  seriously 
as  an  explanation  of  the  movement  of  mankind  toward 
a  certain  goal,  e.g.,  of  universal  peace,  than  are  the  de- 
feats and  victories  of  Israel  as  results  of  disobedience 

24a 


HEALTH  AND  WORLD-PROGRESS       143 

or  of  obedience,  respectively,  to  Jehovah.    This  view  has 
dominated  the  whole  of  Christendom,  and  whether  true 
or  not  is  not  open  to  objective  proof.     The  so-called 
"  principle  of  the  dialectics  of  history  "  propounded  by 
Hegel  is  not  more  satisfactory  from  a  scientific  point 
of  view     "  Reason  is  the  innermost  substance  of  history, 
which  is  logic  in  action."-"  The  victorious  State  is  truer, 
nearer  to  the  ideal  State,  better,  in  a  word,  than  the 
vanquished  State.    The  very  fact  that  it  has  triumphed 
proves  this;  its  triumph  is  the  condemnation  of   the 
principle  represented  by  the  vanquished ;  it  is  the  judg- 
ment of   God.     Thus  interpreted,  history  resembles  a 
series  of  divine  reprisals  directed  against  everything  that 
is  finite,  one-sided,  and  incomplete ;  it^  is  an  eternal  dies 
ir(B,  which  nothing  earthly  can  escape."  "  ,  , 

All  that  needs  to  be  done  by  a  nation  in  order  to  be 
successful  is  to  become  a  true  embodiment  of  the  State- 
Idea  and  it  becomes  that  in  proportion  as  it  defeats  its 
enemies,  since  its  victories  are  a  perpetual  proof  of  its 
approach  to  the  true  purpose  of  the  world-spirit.     1  his 
brings  us  back  to  the  theory  of  Aristotle  that  victorious 
people  always  represent  more  virtue  than  the  vanqmshed. 
Neither  of  these  philosophers  tells  us,  though,  why  one 
conqueror  has  approximated  the  true  idea  of  the  State 
more  than  another,  except  that  the  God  of  history  has 
successively  chosen  the  Egyptians,  Assyrians,  Greeks, 
Romans,  French,  and  the  Germans  as  temporary  and 
privileged  organs.    Whether  these  respective  nations  were 
literally  "  chosen  "  and  later  on  rejected  as  was  Cyrus 
the  Great,  or  whether  they  gradually  evolved  a  truer  idea 
of  the  State  and  then  lost  it,  we  are  not  told.    Victory  is 
the  proof  of  superiority  in  ideas,  defeat  of  inf erionty ; 
but  why  or  how  either  victory  or  defeat  can  be  thus  ex- 
plained is  an  impenetrable  mystery  which  the  God  of  his- 


144       HEALTH  AND  SOCIAL  PROGRESS 

tory  has  not  chosen  to  reveal;  and  all  we  can  do  is  to 
stand  in  awe  and  worship  the  Hegelian  idol. 

2.  The  historical  or  accidental  explanation  of  the 
progress  of  mankind  does  little  more  than  put  its  seal  on 
facts.  Professor  Boas  claims  that  there  is  no  essential 
difference  in  the  ability  of  various  peoples  and  that  the 
earlier  civilization  of  certain  races  was  an  accident.  To 
quote  his  own  conclusion: 

"  Several  races  have  developed  a  civilization  of  a  type  similar 
to  the  one  from  which  our  own  had  its  origin.  A  number  of 
favorable  conditions  facilitated  the  rapid  spread  of  this  civili- 
zation in  Europe.  Among  these,  common  physical  appearance, 
contiguity  of  habitat,  and  moderate  differences  in  modes  of 
manufacture,  were  the  most  potent.  When,  later  on,  civilization 
began  to  spread  over  the  continents,  the  races  with  which 
modern  civilization  came  in  contact  were  not  equally  favorably 
situated.  Striking  differences  of  racial  types,  the  preceding 
isolation  which  caused  devastating  epidemics  in  the  newly  dis- 
covered countries,  and  the  greater  advance  in  civilization,  made 
assimilation  much  more  difficult.  The  rapid  dissemination  of 
Europeans  over  the  whole  world  destroyed  all  promising  be- 
ginnings which  had  arisen  in  various  regions.  Thus  no  race 
except  that  of  Eastern  Asia  was  given  a  chance  to  develop  an 
independent  civilization.  The  spread  of  the  European  race 
cut  short  the  growth  of  the  existing  independent  germs  without 
regard  to  the  mental  aptitude  of  the  people  among  whom  it 
was  developing.  On  the  other  hand,  we  have  seen  that  no  great 
weight  can  be  attributed  to  the  earlier  rise  of  civilization  in  the 
Old  World,  which  is  satisfactorily  explained  as  a  chance.  In 
short,  historical  events  appear  to  have  been  much  more  potent 
in  leading  races  to  civilization  than  their  faculty,  and  it  follows 
that  achievements  of  races  do  not  warrant  us  in  assuming  that 
one  race  is  more  highly  gifted  than  the  other. "  ** 

If  the  earlier  development  of  European  civilization  is 
an  accident  or  a  chance,  no  attempt  at  an  explanation  can 
or  need  be  made,  and  we  are  where  we  were  before — 


HEALTH  AND  WORLD-PROGRESS       145 

facts  are  facts  and  all  that  we  can  do  is  to  accept  them 
and  put  our  seal  of  approval  on  them.  This  is  what 
Hegel  did,  and  found  this  world  the  best  of  all  possible 

worlds.  1  . 

3     The  natural  or  geographical  theories  try  to  explain 

the  progress  of  certain  races  as  a  result  of  topography, 
climate,  and  other  factors  of  nature.  The  Ratzel-Semple 
theory— the  latest  in  this  field— distinguishes  four  funda- 
mental eflfects.  L  direct  physical  effects  of  environment; 
n.  psychical  effects;  HL  economic  and  social  effects; 
IV   effects  upon  movements  of  people. 

(I  )  Physical  effects.  Under  this  head  are  enumer- 
ated: stature,  dominant  activities,  and  pigmentation. 
After  giving  numerous  examples  under  each  sub-division, 
Miss  Semple  admits  the  inadequacy  of  geographical  con- 
ditions to  account  in  full  for  the  effects  cited: 

"The   geographer   must  investigate  the  questions   when   and 
where  deeper  shades  develop  in  the  skins  of  fair  races;  wha 
h  the  significance  of  dark  skins  in  the  cold  zones  and  of  fair 
ones  in  hot  zones.     His  answer  must  be  based  largely  on  the 
:::  lusions  of  physiologists  and  physicists,  and  only  when  thes 
have  reached  a  satisfactory  solution  of  each  detail  of  the  prob 
lem  can   the   geographer   summarize   ^he  influence   oenviro^ 
ment  upon  pigmentation.    The  rule  can  therefore  safely  be  laid 
Town  tL  in  all  investigations  of   geographic  influences  upon 
the  permanent  physical  characteristics  of  races    the  geogra^^^^^ 
distribution  of  these  should  be  left  out  of  consideration  till  the 
last,  since  it  so  easily  misleads." «» 

It  is  not  our  purpose  to  explain  the  origin  of  pigment 
of  the  skin,  but  the  physiologist  referred  to  by  Miss 
Semple  might  get  some  hint  from  the  physician  who  in 
case  after  case  describes  the  complexion  of  hookworm 
victims  as  "  verv  pale,"  '^  extreme  pallor,"  or  an  "  extreme 
pallor  of  a  dirty,  waxy  color  " ;  or  when  we  read  that  pel- 


' 


146      HEALTH  AND  SOCIAL  PROGRESS 

lagra  causes  the  skin  to  thicken  and  become  pigmented. 
And  so  might  the  anthropologist  in  attempting  to  account 
for  stature  when  he  finds  that  these  victims  at  12  or  14 
years  of  age  present  the  appearance  of  children  of  6  to 
8;  or  young  men  and  women  of  18  to  22  that  of  children 
of  12  to  16  years.  Or  when  he  reads  of  brothers,  one 
with  light  infection,  17  years  of  age,  weight  156  pounds; 
the  other  with  heavy  infection,  age  18,  weight  74.  Or 
when  he  finds  that  a  boy  of  16  years  with  very  heavy 
infection  and  ill  for  8  years,  weighed  62>^  pounds  on 
July  29,  1911,  and  79  pounds  on  September  16,  1911— 
a  change  due  solely  to  an  improvement  in  his  blood  after 
the  expulsion  of  the  hookworms,  since  on  August  3,  his 
hemoglobin  was  14  per  cent  and  his  red  corpuscles  num- 
bered 1,050,000;  while  on  September  16,  after  the  ex- 
pulsion of  the  last  parasites  on  the  9th  of  that  month,  the 
figures  stood  55  per  cent  and  4,572,000,  respectively.'^ 

Definite  facts  like  these  should  outweigh  general  theo- 
ries of  what  nature  tends  to  do  or  what  the  influence 
of  this  or  that  hazy  factor  is  supposed  to  do.  For  they 
should  be  taken  in  their  full  bearing.  If  certain  endemic 
diseases  have  been  acting  for  untold  generations  upon 
certain  peoples,  the  effects  become  cumulative,  and  it 
may  well  be  that  an  explanation  of  "  the  significance  of 
dark  skins  in  the  cold  zones  and  of  fair  ones  in  hot 
zones  "  can  be  found.  Or  if  a  people  is  habitually  sub- 
ject to  such  a  disease,  the  average  stature  must  of  neces- 
sity become  low  in  the  course  of  time  through  heredity. 
Illustrations  of  the  effect  upon  complexion  and  stature 
of  only  one  disease  have  just  been  given.  Malaria  has, 
however,  similar  effects.  And  it  was  shown  in  chapter  9 
that  at  the  lowest  estimates  about  50  per  cent  of  the 
people  of  Porto  Rico  were  more  or  less  constantly  ill 
from  the  effects  of  these  two  diseases.    There  are  others 


HEALTH  AND  WORLD-PROGRESS       147 

with  even  more  disastrous  results,  e.g..  venereal;  and 
new  ones  may  be  discovered,  which,  if  local  may  account 
for  many  peculiarities  now  vaguely  attributed  to  race 
or  "  climate."  If  the  influence  of  food  and  occupat^^^^^^^ 
should,  moreover,  be  studied  by  physiologists,  a  further 
explanktion  could,  perhaps,  be  made  concerning  these 

^(nTpsychical    effects.      Among    the    influences    o! 
geography  upon  the  mental  life  Miss  Semple  mentions 
Se  direct  and  indirect;  among  the  former  chiefly  the 
enrichment  of  the  vocabul^y  owing  to  local  environment, 
e  a    of  mountain,  valley,  river,  sea,  and  dependent  occu- 
pations,  as  the  chase,  herding,  navigating  and  a  broader 
effect    upon   the    religion    and    mythology    of    peoples 
Among  the  indirect  influences  mentioned  are  the  general 
STd  of  thought  given  to  man's  mind  by  the  conditions 
which  affect  him  as  an  active  agent,  challenge  his  will  by 
furnishing  motives  for  its  exercise,  give  purpose  and 
XTction  to  his  activities-conditions  which   mold  his 
mind  and  character  through  the  media  of  economic  and 

'"^AU  Ih^s  is  sufficiently  vague  to  be  alluring,  although 
Miss  Semple  does  not  see  that  richness  of  vocabulan^ 
is  but  another  name  for  poverty  in  power  of  ^^^^^^ 
tion,  since  a  more  civilized  man  expresses  the  same  ideas 
by  qualifying  adjectives  and  modifying  adverbs  mstead 
of  having,  for  instance,  four  different  terms  ^or  various 
k  nds  of  mountain  passes.     She  also  overlooks  the  fact 
that  this  richness  in  vocabulary  is  due  rather  to  occupa- 
tions  than  geographic  conditions;  e.g.,  the  Samoyedes, 
who  have  ekven  or  twelve  different  terms  to  designa  e 
the  various  grays  and  browns  of   their  reindeer,  are 
nomads.    A  golf  or  hockey  player  going  to  that  country 
would  most  likely  continue  to  use  his  vocabulary  acqmred 


148       HEALTH  AND  SOCIAL  PROGRESS 

in  Scotland  or  America  notwithstanding  the  difference 
in  geography,   and  an  engineer   would  continue  using 
English,  German,  or  French  terms  in  his  work  and  not 
trouble  himself  about  the  different  words  for  grays  and 
browns  of  reindeer.    Occupation  determines  the  mental 
life  more  than  environment,  as  is  well  illustrated  by  the 
fact  that  the  nation  which  excels  in  any  one  line  of 
activity  creates  a  vocabulary  for  the  whole  world,  since 
language  is  only  the  outward  form  of  ideas.     We  still 
think  in  terms  of  Greek  philosophy,  and  try  to  cast  our 
scientific  terms  in  Greek  or  Latin  vocabularies  simply 
because   these   peoples   excelled   us   in   creating  a   rich 
treasure  of  words  owing  to  their  varied  activities.    France 
was   preeminent   in   automobile  manufacture,  and   the 
terms  invented  in  that  country  in  connection  with  all  that 
this  vehicle  implies,  have  gone  around  the  globe  with  the 
machine.     An  Arab,  accustomed  to  the  fleetness  of  his 
steed,  might  at  first  liken  the  speed  of  an  automobile  to 
that  of  his  favorite  horse,  but  he  would  soon  find  out 
the  inadequacy  of  his  comparison  owing  to  the  ability  of 
the  machine  to  maintain  a  high  speed  all  day,  and  so  he 
would  be  reduced  to  the  necessity  of  speaking  in  terms 
of  the  speedometer.    When  travel  on  foot  was  the  general 
method  of  locomotion,  the  Germans  expressed  distance 
in  terms  of  time,  e.g.,  two  hours,  ten  hours;  now  that 
trains  and  automobiles  have  made  travel  more  varied, 
they  express  it  in  kilometers.    The  next  town  may  still 
be  four  hours  away  to  the  villager,  but  the  distance  to 
Berlin  is  300  kilometers.    Examples  might  be  multiplied 
ad  infinitum  to   show   that   geographical   environments 
merely  gave  figures  of   speech  to  describe  activity  or 
express   ideas,  but   did   not   influence   mental   life   any 
further.    The  hell  of  the  Eskimo  may  be  a  place  of  dark- 
ness, storm,  and  intense  cold,  that  of  the  Jew  one  of 


HEALTH  AND  WORLD-PROGRESS       149 

eternal  fire;  in  both  cases  the  description  of  the  future 
place  of  punishment  is  borrowed  from  local  conditions; 
but  the  idea  of  punishment— both  present  and  future— is 
independent  of  them,  and  will  arise  simultaneously  in  the 
tropics  and  in  the  artics  because  it  is  an  expression  of 
social  needs.    In  proportion  as  numerous  and  varied  activi- 
ties create  more  individual  and  social  needs,  they  have  to 
be  expressed  in  terms  of  language,  and  naturally  enough 
in  words  and  similes  of  the  environment,  because  men- 
tality is  insufficiently  developed  in  lower  civilizations  to 
coin  a  new  general  or  specific  term.     Activity  depends, 
however,  on  health,  and  only  the  direction  it  takes  will 
be  somewhat  influenced  by  the  environment.    The  South 
Sea  islander  will  naturally  be  a  seafarer,  because  that  is 
the  only  way  he  can  find  an  outlet  for  his  energy ;  the 
Kirghis  will  be  a  hunter  or  a  shepherd,  because  that  occu- 
pation alone  is  open  to  him  to  make  a  living.    But  whether 
Samoan  or  Samoyede,  a  sick  man  wants  to  be  disturbed 
as  little  as  possible,  and  hence  develops  only  the  language 
of  the  sickroom— moans  and  groans ;  neither  the  broad- 
ness of  the  sea  nor  the  beauty  of  the  mountains  can  stir 
his  preoccupied  mind  to  invent  anything  else,  unless  it  be 
maledictions,— at    least    while    still    an    unsophisticated 

heathen. 

This  inadequacy  of  accounting  for  man's  mentality  by 
geographic  factors  may  be  seen  better  by  Miss  Semple's 
reference  to  "The  great  man  in  history"  where  she 
mentions  Daniel  Boone,  "  that  picturesque  figure  leading 
the  van  of  the  westward  movement  over  the  Allegheny 
Mountains,  who  was  born  of  his  frontier  environment 
and  found  a  multitude  of  his  kind  in  that  region  of  back- 
woods farms  to  follow  him  into  the  wilderness."  "  Not 
a  word  here  about  the  intense  vitality  of  this  man  who, 
|K)twithstanding  all  his  hardships  and  privations,  lived  to 


il 


11 


150       HEALTH  AND  SOCIAL  PROGRESS 

the  age  of  eighty-five  years;  nor  any  word  about  those 
who  owing  to  poor  vitality  had  to  lag  behind,  but  who 
were  just  as  certainly  the  result  of  their  "  frontier  en- 
vironment "  as  Boone.  The  men  who  left  New  England 
villages  for  the  Middle  West  and  the  Far  West  had 
been  just  as  much  exposed  to  the  geographic  environment 
of  New  England  as  had  those  who  stayed  behind;  they 
had  been  brought  up  under  the  same  climatic  conditions. 
Yet,  there  was  a  difference  between  the  two.  Wherein 
does  it  consist?  The  diflFerence  is  one  in  health.  The 
pioneers  of  every  kind  have  almost  always  enjoyed  good 
health,  and  they  sought  an  outlet  for  their  abounding 
vitality  in  new  fields  and  under  difficult  conditions,  be- 
cause they  felt  confident  that  they  could  master  any 
circumstances.  This  confidence  is  always  bred  by  fine, 
abounding  health,  as  anyone  may  witness  for  himself  if 
he  compares  his  own  hesitancy  and  timidity  in  times  of 
indigestion  or  general  low  vitality  with  his  courage  and 
determination  when  he  is  well  and  strong. 

(HI  and  IV.)  The  economic  and  social  effects,  and  ef- 
fects upon  movements  of  peoples  owing  to  geographic 
environment,  mentioned  by  Miss  Semple,  do  not  call  for 
special  comment,  since  the  purpose  of  our  remarks,  was 
not  to  prove  those  theories  to  be  untrue,  but  rather  to  be 
inadequate  and  vague.  That  natural  barriers,  like  moun- 
tains and  the  sea,  affect  the  economic  systems  of  peoples, 
is  undoubtedly  true ;  but  that  they  are  the  determining  in- 
fluence, is  just  as  undoubtedly  false.  If  some  islands  are 
barren  and  support  a  scant  population,  others  equally 
barren,  e.g.,  Malta  and  the  rocks  of  Tyre  and  Sidon,  may 
support  a  compact  and  teeming  population  whose  influ- 
ence may  be  felt  all  along  the  Mediterranean  and  down 
the  ages  of  history  to  the  present  time.  If  mountains  are 
an  obstacle  to  travel  for  a  primitive  people,  this  is  so 


HEALTH  AND  WORLD-PROGRESS       151 

only  for  those  of  low  vitality ;  since  from  the  mountains 
have  come  the  conquerors  of  the  world  from  immemorial 
times,  at  least  as  far  as  history  records  them.  Rivers 
and  other  favorable  conditions  may  help,  but  do  not  de- 
termine the  migrations  of  peoples.  Those  of  low  vitality 
stay  home  no  matter  how  favorable  circumstances  may 
be ;  no  river  will  tempt  them  to  leave,  and  every  hilltop 
becomes  a  Himalaya. 

Peschel  refers  to  the  influence  of  physical  environ- 
ment upon  man's  religion.  This  is  exercised  through  the 
terrors  of  nature,  influence  of  food  and  of  the  desert.  He 
points  to  the  fact  that  the  founders  of  the  great  mono- 
theistic religions  of  the  world,  Zoroaster,  Moses,  Buddha, 
Christ,  and  Mohammed,  belong  to  the  sub-tropical  zone. 
This  zone  is  one  which  contains  mafly  vast  deserts. 
"  Every  traveler  who  has  crossed  the  deserts  of  Arabia 
and  Asia  Minor  speaks  enthusiastically  of  their  beauties ; 
all  praise  their  atmosphere  and  brightness,  and  tell  of  a 
feeling  of  invigoration  and  a  perceptible  increase  of  in- 
tellectual elasticity;  hence  between  the  arched  heavens 
and  the  unbounded  expanse  of  plain,  a  monotheistic  frame 
of   mind   necessarily   steals   upon   the   children   of    the 

desert."  " 

On  the  other  hand,  "  Buckle  believes  that  the  sublime 
and  terrible  aspects  of  nature  in  India,  exerting  their 
depressing  influence  upon  the  minds  of  the  inhabitants 
for  many  centuries,  have  been  a  considerable  factor  in 
the  development  of  all  that  is  inconsistent  and  supersti- 
tious in  the  Hindoo  culture.  The  threatening  aspects  of 
the  external  world  have  filled  the  minds  of  the  people 
with  images  of  the  grand  and  the  terrible  which  they  have 
striven  to  reproduce  in  the  dogmas  of  their  theology,  in 
the  character  of  their  gods,  and  even  in  the  forms  of  their 
temples.    The  ancient  literature  of  India  shows  evidence 


w 


1'^ 


Di 


152       HEALTH  AND  SOCIAL  PROGRESS 

of  the  most  remarkable  ascendancy  of  the  imagination. 
Most  of  their  works  on  grammar,  on  law,  on  medicine, 
on  geography,  on  mathematics,  and  on  metaphysics  are 
in  the  form  of  poetry.  There  is  an  excessive  reverence 
for  antiquity."  ®*  He  believes  that  man  is  affected  by 
four  classes  of  physical  agents — climate,  food,  soil,  and 
the  general  aspect  of  nature. 

The  dryness  and  brightness  of  the  atmosphere  of  the 
deserts  mentioned,  the  consequent  comparative  freedom 
from  disease  germs,  and  the  resulting  feeling  of  invigo- 
ration  and  perceptible  increase  of  intellectual  elasticity, 
are  likely  to  have  more  to  do  with  a  monotheistic  con- 
ception than  the  arched  heavens  and  the  unbounded  ex- 
panse of  plain.  Else,  why  did  peoples  in  other  plains, 
such  as  the  prairies,  steppes,  and  pampas,  not  develop 
monotheistic  conceptions?  And  why  did  sea-faring  na- 
tions, hke  the  Phoenicians  and  the  Greeks  who  had  a 
more  broadly  arched  heaven  and  a  wider  expanse  to 
deal  with,  develop  the  polytheistic  systems  of  religion 
with  the  greatest  diversity  of  gods?  The  possible  ob- 
jection that  the  Greeks  had  a  variegated  landscape  to  live 
in,  does  not  hold,  since  that  objection  could  be  raised 
against  Zoroaster,  and  all  the  other  founders  of  mono- 
theistic religions,  because  all  of  them  were  living  in 
countries  where  plains  and  mountains  changed  the  land- 
scape. Of  Moses  we  are  told,  moreover,  that  he  was  fond 
of  mountains,  since  he  "  saw  God  on  Mount  Sinai "  and 
received  the  Ten  Commandments  there ;  and  before  he 
died  he  "  went  up  from  the  plains  of  Moab  unto  the 
mountain  of  Nebo,  to  the  top  of  Pisgah,"  evidently  be- 
cause the  much  broader  expanse  from  a  high  elevation 
with  the  varied  scenery  of  all  the  land  of  Judah  unto  the 
utmost  sea,  seemed  to  him  more  like  the  dwelling  place 
of  Jehovah  than  the  hot,  sandy,  and  dusty  plain.    Neither 


HEALTH  AND  WORLD-PROGRESS        153 

was  Jesus  averse  to  mountains,  since  He  preached  His 
first  sermon  there,  was  transfigured  there,  and  captured 
there.  The  fact  that  both  lived  in  the  desert  for  a  while 
as  did  Elijah— who  by  the  way  *'  went  to  Horeb,  the 
Mount  of  God  "—and  others,  like  Mohammed,  need  dis- 
turb no  one,  since  such  a  short  time  would  not  suffice  to 
turn  polytheists  into  monotheists,  unless  Peschel  is  will- 
ing to  concede  miraculous  powers  to  the  "  arched  heavens 
and  the  unbounded  expanse  of  plain  "  in  some  particular 

parts  of  the  globe. 

Concerning  Buckle's  statement  about  the  mind  of  the 
Hindoo,  it  may  be  more  profitable  to  refer  to  the  humble 
mosquito  and  the  hookworm,  as  the  causes  of  malaria 
and  uncinariasis,  respectively,  than  to  the  "  sublime  and 
terrible  aspects  of  nature  in  India."    In  a  country  where 
between  60  and  80  per  cent  of  the  people  are  infected 
with  anchylostomiasis  and  perhaps  an  equal  number  with 
malaria— the  blood  thus  never  being  normal— the  imagi- 
nation is  apt  to  become  rather  lively  and  unrestrained,  so 
that  the  following  tale  may  not  appear  incredible  to  the 
average   Hindoo.     An  eminent   man  "  lived  in  a  pure 
and  virtuous  age,  and  his  days  were  indeed  long  in  the 
land,  since  when  he  was  made  king  he  was  a  million 
years -old;  he  then  reigned  six  million  three  hundred 
thousand  years ;  having  done  which,  he  resigned  his  em- 
pire, and  lingered  on  for  one  hundred  thousand  years 


more. 


♦»  »4 


^ This  man  was  the  first  king,  anchorite,  and 

saint.     But  even  common  mortals  lived  on  an  average 
80,000  to  100,000  years. 

We  found  that  the  jibaro  of  Porto  Rico  is  equally 
superstitious  and  unrestrained  in  his  imagination,  and 
that  voodooism  may  be  on  the  same  level  as  the  jugger- 
naut or  sacrifice  of  children  to  crocodiles,  for  in  such 
countries  life  is  made  almost  unendurable  owing  to  en- 


> 


2 


i 


154       HEALTH  AND  SOCIAL  PROGRESS 

demic  diseases  and  occasional  epidemics,  so  that  relief 
from  such  a  condition  would  be  welcomed  at  any  price. 
Buddha, — born  in  the  Himalayan  piedmont  where  ano- 
pheles and  uncinaria  flourish,  and  fighting  the  lassitude 
induced  not  so  much  by  heat  and  humidity,  against  both 
of  which  there  is  protection  through  shade  and  rest,  but 
by  endemic  diseases  against  which  there  is  no  protection 
except  quinine  and  thymol, — may  well  have  pictured  his 
heaven  as  Nirvana,  the  cessation  of  all  activity  and  in- 
dividual life.  For  low  vitality  produces  aversion  to  activ- 
ity and  begets  veneration  for  the  past,  since  all  progress 
has  to  be  bought  with  the  outlay  of  energy  which  must 
be  abundant  if  new  ventures  are  to  be  entered  upon. 
Diseases  of  the  kind  discussed  are  more  important  as  a 
cause  of  low  vitality  and  enervation  than  heat,  as  is 
proved  by  the  fact  that  the  sufferers  from  hookworm  in 
Tennessee  and  the  neighboring  States  with  their  mild  and 
salubrious  climate  are  undergoing  the  same  process  of 
degeneration  as  the  Hindoos,  although  in  the  one  case 
the  trouble  was  formerly  laid  to  the  heat,  in  the  other  to 
laziness  and  shiftlessness.  We  know  now  that  this 
disease  is  one  of  the  principal  causes  of  decadence.  "  Is 
it  *  laziness  *  or  disease  that  is  this  very  day  attracting  the 
attention  of  the  United  States  to  the  descendant  of  the 
pure-blooded  English  stock  in  the  Southern  Appalachian 
Range,  in  the  mountains  of  Carolina  and  Tennessee,  the 
section  of  our  country  where  the  greatest  predominance 
of  *  pure  American  blood  *  occurs,  despised  by  the  negro 
who  calls  him  *po'  white  trash'?"" 

If  results  of  this  kind  are  found  in  a  temperate  climate, 
in  States  which  are  fast  filling  up  with  health  resorts, 
and  among  a  stalwart  population  which  left  England  less 
than  300  years  ago,  one  can  easily  figure  out  what  they 
must  be   where   this   disease — usually   connected   with 


HEALTH  AND  WORLD-PROGRESS       155 

malaria  and  most  likely  with  other  forms  of  sickness- 
has  been  exerting  its  noxious  influence  upon  untold  gen- 
erations under  less  favorable  climatic  and  civilizing  con- 
ditions. While  it  would  be  wrong  to  exclude  the  heat  of 
India  as  a  factor  in  the  mental  and  physical  degeneracy 
of  the  Hindoos,  it  can  certainly  no  longer  be  looked  upon 
as  the  principal  cause  when  similar  results  are  noticed 
on  a  superior  people  under  really   favorable  cHmatic 

conditions. 

There  has  been  a  strong  tendency  to  lay  the  blame  for 
all  the  shortcomings  of  white  men  in  the  tropics  and 
sub-tropics  upon  the  heat,  instead  of  looking  for  exact 
causes.     Among  the  latter  we   find   social   and  moral 
causes  as  well  as  those  of  climate.    It  has  not  been  taken 
into  consideration  that  many  a  supposedly  moral  man 
is  kept  from  wrong-doing  in  his  old  home  by  all  the  props 
which  civilization,  family  history,  association  with  better 
men,  and  the  whole  social  system,  provide.     When  this 
man  is  sent  to  a  people  on  a  lower  plain  of  civilization, 
perhaps  in  a  position  of  authority  with  all  the  tempta- 
tions implied,  and  all  props  removed,  the  inevitable  result 
is  the  revelation  of  his  true  nature.    He  will  commit  deeds 
for  which  at  home  he  lacked  power  and  opportunity ;  but 
we  sympathetically  lay  the  blame  on  the  climate,  especi- 
ally in  the  tropics.     When  a  Sicilian,  well-behaved  at 
home,  turns  "  black  bander  "  in  New  York,  the  climate 
is  not  blamed,  since  we  lay  the  cause  to  poor  moral 
training  at  home,  poor  police  service,  or  economic  con- 
ditions.   Only  when  the  Italian  tries  to  make  an  honest 
living  by  hard  work  but  fails  to  do  so  and  goes  insane, 
is  the  climate  of  New  York  or  New  Jersey  held  responsi- 
ble ;  whereas  we  ought  to  look  for  the  cause  in  his  poor 
physical  and  mental  condition,  which  makes  it  impossible 
for  him  to  cope  with  a  new  and  complex  social  environ^ 


156       HEALTH  AND  SOCIAL  PROGRESS 

ment.  In  the  past  Providence  was  looked  upon  as  the 
ultimate  cause  of  our  failings;  now  we  are  inclined  to 
make  climate  the  scapegoat.  That  is  neither  fair  nor 
scientific.  We  should  look  for  individual  causes.  Lord 
Clive  gathered  treasures  for  himself  in  India,  Lord 
Kitchener  did  not;  many  men  have  given  the  general 
low  moral  tone  in  African  communities  as  an  excuse 
for  their  failings;  Livingstone,  fever-stricken  and  gaunt 
from  exhaustion,  but  still  in  possession  of  a  good  Scotch 
constitution  and  conscience,  maintained  a  high  moral 
standard.  If  we  try  to  blame  the  climate,  definiteness 
of  statement  is  necessary;  but  that  is  generally  lacking, 
and  a  vague  term  is  used  to  cover  a  multitude  of  sins. 
We  know  that  in  the  case  of  disease  certain  forms  of 
physical  and,  mferentially  at  least,  mental  derangements 
take  place;  repeated,  as  in  the  case  of  endemic  diseases, 
in  hundreds  of  generations  they  must  produce  at  least 
grave  enfeeblement  of  body  and  mind.  Would  it  not 
be  better  to  blame  diseases,  local  or  general  in  the  tropics, 
rather  than  climate  ? 

Two  books  by  Ellsworth  Huntington  have  appeared 
recently,  w^hich  have  a  special  claim  for  more  extensive 
remarks  in  this  connection.*  While  Buckle  and  Peschel 
never  adduce  any  but  the  most  general  arguments  in  sup- 
port of  their  theses  about  the  influence  of  geographical 
and  climatical  conditions.  Dr.  Huntington  is,  at  least  in 
the  first  part  of  his  book,  very  specific.  It  may  be  best 
to  have  the  author  speak  for  himself.  He  says,  (pp.  9 
and  10) : 

"  The  hypothesis,  briefly  stated,  is  this :  Today  a  cer- 


*  Civilization  and  Climate,  by  Ellsworth  Huntington,  Ph.D., 
Yale  University  Press,  191 5;  also  World  Power  and  Evolu- 
tion, ibid.,  1919.  References  are  to  the  first  work  only,  since 
the  second  contains  no  new  principle. 


HEALTH  AND  WORLD-PROGRESS       157 

tain  peculiar  type  of  climate  prevails  wherever  civiliza- 
tion is  high.     In  the  past  the  same  type  seems  to  have 
prevailed  wherever  a  great  civilization  arose.    Therefore, 
such  a  climate  seems  to  be  a  necessary  condition  of  great 
progress.    It  is  not  the  cause  of  civilization,  for  that  lies 
infinitely  deeper.     Nor  is  it  the  only,  or  the  most  im- 
portant condition.    It  is  merely  one  of  several,  just  as  an 
abundant  supply  of  pure  water  is  one  of  the  primary 
conditions  of  health.    Good  water  will  not  make  people 
healthy,  nor  will  a  favorable  climate  cause  a  stupid  and 
degenerate  race  to  rise  to  a  high  level.     Nevertheless,  if 
the  water  is  bad,  people  cannot  retain  their  health  and 
strength,  and  similarly  when  the  climate  becomes  unfit, 
no  race  can  apparently  retain  its  energy  and  progressive- 
ness.    This  does  not  mean  that  we  are  hopelessly  at  the 
mercy  of  the  changes  of  climate  which  any  century  may 
bring  forth.    On  the  contrary,  if  our  diagnosis  is  correct, 
we  may  at  last  hope  to  be  free  from  the  withering  blight 
which  has  overtaken  every  race  from  which  the  stimulus 
of  a  good  climate  has  been  removed.     Here,  again,  the 
case  is  like  that  of  a  water  supply.    Suppose  that  a  com- 
munity  had   for  generations   been   subject   to   repeated 
visitations  of  a  dread  disease  which  decimated  the  popu- 
lation.    Suppose  that  it  should  be  discovered  that  the 
disease  arose  from  the  drinking  water.     Finally,  let  the 
community  learn  that  the  water  is  infested  with  the  bac- 
teria which  cause  typhoid  fever.    If  no  other  water  sup- 
ply were  available,  would  there  be  reason  for  despair? 
The  disease  would  be  no  worse  than  before,  and  there 
would  be  hope  of  finding  some  way  of  protecting  the 
water  from  contamination.     So  it  is  with  climate.     For 
ages  the  world  appears  to  have  been  suflFering  because  one 
of  the  many  conditions  of   progress  has   changed   re- 
peatedly from  century  to  century.    The  disease  has  been 


158       HEALTH  AND  SOCIAL  PROGRESS 

clear  enough,  and  we  have  devised  many  helpful  ways 
of  treating  the  patients,  although  none  has  as  yet  proved 
highly  satisfactory.  This  does  not  mean  that  the  treat- 
ment has  been  wrong,  or  that  we  cannot  ultimately  suc- 
ceed. It  merely  means  that  the  neglect  of  one  particular 
phase  of  the  matter  has  prevented  the  other  helpful 
measures  from  producing  their  full  effect.  If  nature 
does  not  provide  the  stimulus  which  seems  so  effective 
elsewhere,  man  must  himself  provide  it." 

The  case  for  endemic  diseases  as  the  cause  of  the 
retardation  of  civilization  could  not  have  been  stated 
more  clearly  than  by  Dr.  Huntington.  We  have  dis- 
covered the  "  bacteria  which  cause  typhoid,"  malaria,  and 
hookworm  disease,  and  have  made  formerly  unhealthy 
regions  inhabitable  by  man,  and  intolerable  climates  en- 
durable. The  uncertain  factor  of  "  climate  "  has  been 
brought  down  to  something  specific,  and  has  been  con- 
quered, and  will  be  subjected  to  an  ever  greater  degree 
of  control  in  proportion  as  we  let  generalities  go  and 
search  for  details.  That  is  the  whole  thesis  of  this  book. 
Man  has  progressed  in  exact  proportion  as  he  has  made 
himself  independent  of  certain  factors  in  his  environ- 
ment. Disease  is  one  of  these,  and  the  most  important. 
For  not  even  Dr.  Huntington  claims  that  we  shall  be 
able  to  change  the  heat  of  the  tropics  or  the  cold  of  the 
arctics.  He  admits  (p.  285)  that  the  climatic  hypothesis 
seems  depressing,  because  to  the  dweller  in  less  favored 
regions  the  death  knell  seems  to  have  sounded  for  any 
progress,  while  to  the  inhabitant  of  present  centers  of 
great  activity  a  most  disquieting  vision  of  possible  retro- 
gression is  disclosed.  He  proceeds,  however,  to  dispel 
these  fears. 

In  our  factories  we  may  introduce  changes  in  tempera- 
ture to  imitate  those  of  nature  where  she  does  not  provide 


HEALTH  AND  WORLD-PROGRESS       159 

them.  Work  ought  to  be  regulated  according  to  the 
"  seasonal  curve  of  energy,"  and  machines  should  be 
made  to  run  slowly  in  winter,  faster  in  the  spring,  less 
fast  in  summer,  very  fast  in  the  autumn.  We  should  each 
one  of  us  go  to  Florida  or  Southern  California  in  the 
winter;  the  Russian  peasants  might  be  transported  to 
Mesopotamia  for  a  sojourn  between  October  and  May  to 
help  the  Turk  till  his  fields,  and  in  the  tropics  houses 
might  be  cooled  just  as  we  heat  our  houses  in  winter, 
or  people  might  have  one  house  in  the  lowlands  and  an- 
other in  the  uplands,  varying  their  residence  between  the 
two  seasonally  or  even  weekly.  The  thought  of  the  ex- 
pense does  not  deter  the  author  in  the  least,  since  the 
farmers  in  the  tropics  will  be  two  or  three  times  as  pro- 
ductive as  European  peasants  are  at  present  (pages  289- 
293). 

This  may  be  possible  some  time ;  at  least,  we  may  hope 
so.  But  how  about  the  disease  germs?  Are  they  going 
to  disappear  with  these  changes  in  residence  and  in  varia- 
tion of  the  temperature?  Or  are  tropical  diseases  likely 
to  affect  a  larger  number  of  people  than  now  ?  There  is 
only  one  thing  to  do — to  make  the  tropics  healthy  by 
eliminating  the  diseases  as  far  as  possible.  Wherever 
modern  methods  have  been  applied  the  three  most  preva- 
lent and  pernicious  of  them  have  been  conquered — yellow 
fever,  malaria,  and  uncinariasis.  It  has  been  done  in 
places  as  far  apart  as  Ismailia,  and  Stephansort,  New 
Guinea;  Port  Said  and  the  Federated  Malay  States; 
Khartoum  and  Italy;  Greece  and  Panama;  Cairo  and 
Porto  Rico ;  Hong  Kong  and  Sierra  Leone.  There  is  no 
need  to  wait;  we  have  the  means,  and  we  shall  soon 
have  more.  The  testimony  of  physicians  of  the  reputa- 
tion of  Major  General  William  C.  Gorgas  and  Sir 
Ronald  Rpss  cannot  be  gainsaid,     One  of  the  worst 


160       HEALTH  AND  SOCIAL  PROGRESS 

regions  on  the  whole  globe  has  always  been  the  West 
Coast  of  Africa.  Ross  reports  *  that  statistics  covering 
the  period  1881  to  1897  showed  a  death  rate  of  75.8  per 
1,000  among  the  European  officials  on  the  Gold  Coast, 
and  53.6  for  Lagos.  In  1911  it  was  13.9  for  the  whole 
of  the  British  West  African  Colonies ;  and  the  invaliding 
rate  was  only  25.2  per  1,000. 

No  one  will  claim  that  changes  in  temperature  are  not 
beneficial,  nor  that  too  protracted  heat  or  cold  are  not 
injurious ;  and  Dr.  Huntington  is  evidently  right  in  call- 
ing our  attention  to  them.  But  if  it  is  in  our  power  to 
improve  health  in  the  tropics  now,  why  wait  for  that 
golden  day  when  the  dwellers  in  Mesopotamia  will  be 
glad  to  entertain  ten  or  fifteen  millions  of  Russian 
peasants  during  the  winter  in  order  to  give  them  a  neces- 
sary change  of  air?  Healthy  men  make  their  own  ar- 
rangements ;  it  is  the  sick  who  need  to  be  told  what  to  do. 

It  is  only  fair  to  state  that  Dr.  Huntington  puts  forth 
his  hypothesis  with  hesitation,  and  freely  admits  that 
other  factors  have  been  important  as  promoters  of  civili- 
zation. The  theory  itself  concerns  us  only  indirectly. 
It  is  briefly  as  follows :  Qimate — temperature,  humidity, 
and  storminess — either  promotes  or  retards  health.  If 
there  is  a  proper  temperature — "  mental  optimum  of  38 
degrees  F.  and  physical  optimum  of  60  or  possibly  65 
degrees  F."  (p.  129) — with  a  certain  amount  of  humidity 
suitable  to  different  localities,  and  a  fair  amount  of 
storminess  to  insure  sufficient  daily  and  seasonal  changes, 
we  have  an  ideal  climate.  Variations  from  this  desidera- 
tum are  possible,  but  not  too  far  in  either  direction,  if  the 
best,  or  even  good,  results  are  to  be  obtained.  On  the 
basis  of  these  three   features  the  author  constructs  a 

*  Health  Preservation  in   West  Africa,  by  J.  Charles  Ryan, 
with  preface  by  Sir  Ronald  Ross,  London,  1914, 


HEALTH  AND  WORLD-PROGRESS       161 

map  of  human  energy  with  diflFerent  degrees  of  intensity, 
(p.  142).  The  "very  high"  areas  cover  the  British 
Isles,  Germany,  France,  Austria,  the  Baltic  provinces, 
Denmark,  Southern  Sweden  and  Norway,  Northern  and 
Central  Italy,  and  the  larger  part  of  the  United  States. 
These  areas  are  surrounded  by  others  of  "  high "  in- 
tensity, to  which  are  added  a  few  isolated  regions,  e.g., 
Japan,  New  Zealand,  Patagonia,  Tasmania,  and  some 
smaller  ones.  The  "  medium "  areas  include  most  of 
Asia,  the  southern  coast  of  Australia,  Mexico,  the  larger 
part  of  Canada,  the  southern  part  of  South  America, 
the  northern  part  of  Africa,  the  eastern  and  southern 
coast  of  Africa,  and  a  few  other  smaller  areas.  The 
"  low "  areas  include  the  northern  and  southern  parts 
of  Asia,  the  larger  part  of  Australia,  the  northern  part 
of  Canada,  and  the  islands  of  the  Indian  Archipelago. 
The  "  very  low  "  areas  take  in  most  of  South  America 
and  Africa,  and  a  few  other  small  regions. 

He  claims  that  only  in  the  "  very  high  "  areas  does  a 
high  civilization  exist  at  present,  because  only  there  are 
climatic  conditions  favorable.  Perhaps  no  exception  can 
be  taken  as  to  the  actual  present  conditions.  His  infer- 
ence is  that  similarly  favorable  conditions  must  have  ex- 
isted in  the  past  wherever  a  high  civilization  arose,  and 
in  order  to  prove  its  correctness,  he  has  originated  a 
theory  called  "  pulsations  of  climate,"  covering  from  one 
to  several  centuries  each.  He  admits  it  to  be  only  an 
hypothesis,  not  accepted  as  yet  by  meteorologists  for 
historic  times,  at  least.  Yet  he  proceeds  to  apply  it  to 
history.  Whether  there  were  changes  of  climate  in 
prehistoric  times  does  not  concern  us  here,  because  we 
are  interested  only  in  historic  man.  Of  the  Neanderthal 
man  we  know  nothing  except  that  he  lived  and  that  his 
intelligence  was  comparatively  low.    Our  civilization  has 


162       HEALTH  AND  SOCIAL  PROGRESS 

not  benefited  from  him  in  the  least.  It  may  be  best 
to  take  up  some  of  Dr.  Huntington's  historical  illustra- 
tions. 

Mesopotamia,  (p.  257  if.)  the  author  claims,  had  a 
high  civilization,  and  was  invaded  successively  by  various 
peoples,  each  of  whom  became  civilized.     According  to 
his  hypothesis  they  owed  this  power  at  least  in  part  to  the 
favorably  stimulating  climate.     But  how  can  that  be? 
If  these  peoples  were  living  in  a  healthier  climate,  had 
better  food  and  houses,  and  more  advanced  means  of 
offense  and  defense,  and  were  generally  stronger  and 
more  intelligent  owing  to  their  higher  civilization— how 
could   another   people,    inferior   in   all    these    respects, 
permanently  conquer  them?     And  how,  in  turn,  after 
acquiring  all  the  advantages  of  their  subjects,  could  they 
be  reduced  to  the  condition  of  slaves  or  vassals  by  an- 
other inferior  people  ?    It  would  be  a  unique  phenomenon 
in  the  annals  of  history,  since  according  to  hypothesis  the 
climate  did  not  change  from  around  3000  b.c.  to  ap- 
proximately  500   B.C.— the   period   in   which   we   have 
these  successive  invasions.     Nowhere  in  history  do  we 
find  an  analogous  case.     The  Huns,  the  Mongols,  and 
the  Avars  invaded  Europe,  but  they  were  thrust  back 
after  a  short  occupation  of  parts  of  it,  and  perhaps  few  of 
them  remained  in  the  conquered  territories.    The  Moors, 
it  is  true,  occupied  Spain  for  approximately  600  years. 
It  is,  however,  a  question  whether  their  energy  and  civili- 
zation were  inferior  to  those  enjoyed  by  the  various  tribes 
inhabiting  Spain  during  that  period.     Everywhere  we 
find  that  a  physically  healthy  and  mentally  capable  people 
succeeds  in  subjugating  a  disease-ridden,  although  per- 
haps more  civilized,  nation.     Mesopotamia  was  no  ex- 
ception to  the  rule.    There,  as  elsewhere,  the  people  from 
the  mountains  and  highlands,  after  having  acquired  strong 


HEALTH  AND  WORLD-PROGRESS       163 


vitality  in  comparatively  disease-free  regions,  swooped 
down  upon  the  cities  and  villages  in  the  germ-laden  plains, 
and  easily  subjected  the  inhabitants.  An  efflorescence  of 
a  higher  mental  and  civilizational  life  was  inevitable  in  a 
healthy  and  gifted  but  undeveloped  people  under  the 
stimulus  of  contact  with  a  higher  civilization,  and  a  life 
of  leisure  based  on  slavery.  The  subsequent  infection 
and  low  vitality  in  the  course  of  time  was  just  as  in- 
evitable. No  theory  of  a  change  of  climate  is  necessary 
to  account  for  the  civilization  of  Mesopotamia  or  Egypt, 
which  has  been  similarly  ruled  by  outsiders  in  historic 
times. 

Another  interesting  illustration  of  the  hypothesis  of 
Dr.  Huntington  is  that  of  the  civilization  of  the  Mayas 
in  Yucatan  (p.  239  ff.).  These  remarkable  people  at- 
tained many  achievements  of  high  degree  in  a  tropical 
country.  How  is  it  to  be  explained  ?  Only  by  a  **  climatic 
change  such  that  the  dry  conditions  which  prevail  a 
little  farther  north  prevailed  in  the  Maya  region  when 
these  people  attained  eminence  "  (p.  242).  In  the  drier 
parts  of  Yucatan  where  some  of  the  ruins  of  the  Mayas 
are  located,  there  lives  even  today  a  fairly  prosperous 
agricultural  people ;  fevers  prevail,  but  are  comparatively 
mild.  The  Guatemalan  highlands  with  fairly  favorable 
conditions  are  only  a  hundred  miles  away.  Does  this  not 
suggest  a  solution  which  is  almost  world-wide  in  applica- 
tion— the  migrations  from  the  highlands  to  the  low- 
lands by  a  strong  and  energetic  people  ?  What  happened 
in  Mesopotamia  and  Egypt  would  naturally  happen  here, 
too,  and  successive  invasions  would  account  for  the  dif- 
ferent periods  in  Maya  history. 

Dr.  Huntington  admits  that  the  civilizations  of  Peru, 
Southern  Arabia,  Rhodesia,  Ceylon,  Java,  and  Indo-China 
cannot  be  explained  on  the  basi$  of  a  shifting  of  climatic 


164       HEALTH  AND  SOCIAL  PROGRESS 

zones,  and  admits  that  those  of  Ceylon  and  Indo-China 
may  be  due  to  migrations  from  higher  latitudes. 

The  strongest  objection  to  his  theory,  Dr.  Huntington 
states  himself  (p.  276  ff.).  The  North  American  Indians 
lived  mostly  in  the  very  high  or  high  energy  area,  and 
yet  never  passed  beyond  the  lower  stages  of  semi-civiliza- 
tion. He  frankly  admits  the  insolubility  of  this  particu- 
lar case,  and  falls  back  on  the  absence  of  other  factors 
contributory  to  civilization — chiefly  the  lack  of  iron  and 
of  great  men  with  inventive  ability. 

This  is  a  candid  acknowledgment  of  the  failure  of  his 
own  theory.  Other  peoples  started  out  with  a  similar 
lack  of  both,  and  were  climatically  less  favorably  situ- 
ated, e.g.,  the  Incas  and  Aztecs,  who  were,  moreover,  of 
the  same  racial  stock.  The  only  explanation  is  that  which 
we  have  found  to  apply  elsewhere.  Most  of  these  Indians 
lived  in  the  belt  which  includes  both  malaria  and  unci- 
nariasis. If  these  diseases  can  work  so  much  havoc  today 
in  the  Appalachian  Mountains  among  a  formerly  sturdy 
people,  the  inference  suggests  itself  that  the  aborigines 
must  have  suffered  more.  The  most  highly  developed 
tribes  were  the  Five  Nations  who  suffered  from  malaria 
only;  just  how  severely  no  one  can  tell.  They  were, 
moreover,  handicapped  in  another  way.  As  will  be 
shown  later,  local  civilizations  can  never  rise  very  high, 
because  the  contacts  between  individuals  are  too  few  and 
too  similar  to  stimulate  the  mind  by  divergent  sugges- 
tions. In  other  words,  the  areas  that  are  comparatively 
free  from  endemic  diseases  must  be  fairly  large,  or  must 
permit  intercourse  with  many  nations  by  the  use  of  the 
sea.  The  Five  Nations  were  an  inland  people,  and  while 
they  occupied  a  very  much  larger  area  than  the  Greeks, 
they  were  shut  off  from  contact  with  other  nations.  The 
prevalence  of  malaria  not  only  kept  vitality  low,  but 


HEALTH  AND  WORLD-PROGRESS       165 

prevented  an  increase  of  population  to  a  point  of  density 
where  contacts  might  be  fairly  varied  and  numerous  even 
among  themselves.  Contact  with  the  sea  is  no  longer 
necessary  in  a  world-wide  civilization,  because  we  have 
the  railroads  and  other  means  of  communication.  Hence 
this  handicap  has  been  removed,  and  the  hinterlands 
of  continents  have  already  been  developed,  and  are  likely 
to  see  a  higher  civilization  in  the  future.  The  idea  of 
geographers  that,  just  because  plateaus  are  removed  from 
the  sea,  they  are  incapable  of  sustaining  a  fairly  high 
civilization,  has  already  been  corrected  by  our  artificial 
means  of  communication.  In  the  past  they  were  isolated ; 
now  they  are  brought  into  contact  with  the  rest  of  the 
world.* 

One  point  more  must  be  mentioned.  Dr.  Huntington 
testifies  (p.  39)  to  the  ravages  of  malaria  on  mind  and 
body  in  torrid  countries,  and  claims  that  tropical  diseases 
will  always  prevail  there,  owing  to  the  prohibitive  ex- 

*  It  is  risky  to  be  a  prophet,  and  it  is  difficult  to  foretell  what 
will  happen  in  the  plateaus  and  other  areas  removed  from  the 
sea.     In  America  we  have  succeeded  in  overcoming  the  natural 
handicaps  of  isolation.     Similar  success  is  likely  to  be  attained 
elsewhere,  e.g.,  in  the  plateaus  of  China  and  in  the  plains  of 
Siberia.    Huntington  (p.  145)  puts  the  blame  of  the  backward- 
ness of  Siberia  on  climate,  yet  admits  (p.  201)  that  the  isolation 
and  newness  of  the  country  has  much  to  do  with  it.    Professor 
E.  A.  Ross  in  a  report  of  a  six  months*  trip  through  Russia 
and  Siberia  claims  that  social   factors  are  responsible   for  the 
mental  inertness  of  Russian  exiles.     They  have  no  stimulating 
intercourse,  no  large  libraries,  and  above  all  no  incentive   for 
action  and  exertion  owing  to  their  more  or  less  strict  confine- 
ment.    They  have  no  opportunity  to  study  facts  at  first  hand, 
and  rotate  around  the  adolescent  formulae  which  they  took  with 
them  ('•  Studies  in  Social  Progress,"  June  1918).    Other  regions 
now  densely  populated  and  highly  civilized  were  once  similarly 
looked  upon  as  given  over  to  barbarism.     Caesar  and  Tacitus 
certamhr   never   imagined   what   civilization   there   would   be   in 
Gaul,  England,  and  Germany  in  the  twentieth  century.     Human 
factors  are  not  omnipotent,  but  they  are  powerful  agencies  for 
overcoming   natural   handicaps,  and  are   becoming  increasingly 
more  so  every  day. 


166       HEALTH  AND  SOCIAL  PROGRESS 

pense  of  extirpating  them.  This  point  will  be  taken  up 
in  detail  in  chapters  12  and  14.  In  his  latest  work  he 
admits  malaria  to  have  been  a  factor  in  the  decadence  of 
ancient  Rome  and  in  modem  Turkey,  as  explained  in  the 
Note  to  chapter  7. 

4.  The  anthropological  attempts  to  explain  progress 
are  based  (a)  on  the  weight  of  the  brain,  (b)  on  the 
form  of  the  skull,  (c)  on  other  physical  characteris- 
tics. 

The  weight  of  the  brain  is  no  longer  considered  of 
fundamental  importance,  since  we  find  that  some  men  of 
genius  have  had  smaller  brains  than  the  average  of  their 
nation.  The  brain  of  Helmholtz  weighed  only  45  ounces, 
and  that  of  Doellinger  only  37.7.  While  the  white  race 
has  a  generally  higher  brain  weight  than  the  black,  the 
differences  among  the  lowest  and  highest  Europeans  are 
greater  than  the  average  between  the  white  and  black. 
After  an  examination  of  2,100  male  and  1,034  female 
adults,  there  is,  according  to  Karl  Pearson,  "  no  evidence 
that  brain  weight  is  sensibly  correlated  with  intellectual 
ability.  Of  the  five  races  investigated  by  the  biome- 
tricians,  the  English  have  the  smallest  brain  weight.  The 
mean  of  the  adult  Englishman  is  27  grams  less  than  the 
Bavarian  mean,  57  grams  less  than  the  Hessian  mean,  65 
grams  less  than  the  Swedish  mean,  and  120  grams  less 
than  the  Bohemian  mean."  ••  Other  brain  specialists  and 
anthropologists  concur  in  this  verdict,  e.g.,  Boas  in  his 
discussion  of  "  The  Mind  of  Primitive  Man,"  where  he 
quotes  (p.  24)  another  passage  from  Pearson  to  the 
same  effect.  Donaldson  says :  "  Size,  therefore,  has  a 
meaning,  but  it  is  by  no  means  entitled  to  dominate  the 
whole  interpretation  of  the  central  system."  '^  There  is 
no  need  of  carrying  the  argument  further,  since  the 
burden  of  proof  rests  on  those  who  a  priori  regard  ^ 


HEALTH  AND  WORLD-PROGRESS       167 

association  of  brain  weight  and  high  intelligence  in- 
separable. 

The  form  of  the  skull  is  considered  still  less  funda- 
mental, since  the  same  head  form  is  found  among  the 
most  backward  and  the  most  advanced  peoples.  The 
cephalic  index  of  the  Bushmen  is  75.9,  that  of  the  Swedes 
of  the  central  provinces  is  76.0,  both  being  sub-dolichoce- 
phalic; both  the  natives  of  New  Ireland  and  the  Dutch 
of  the  province  of  Groeningen  have  a  cephalic  index  of 
81.0  on  the  living  subject.  Similar  comparisons  might 
be  multiplied  indefinitely,  but  would  only  prove  the  un- 
tenability  of  the  theory  more  fully.  Other  measurements 
have  likewise  yielded  unsatisfactory  results.  "  I  think 
all  the  investigations  that  have  been  made  up  to  the 
present  time  compel  us  to  assume  that  the  characteristics 
of  the  osseous,  muscular,  visceral,  or  circulatory  system, 
have  practically  no  direct  relation  to  the  mental  ability 
of  man." »» 

5.  Major  WoodruflF's  theory  of  the  actinic  rays  is  an 
attempt  to  explain  the  progress  of  civilization  on  the  basis 
of  a  high  type  of  man  developed  in  the  Baltic  provinces. 
In  regard  to  the  various  attempts  to  explain  high  men- 
tality on  anthropological  grounds  he  says :  "  It  should 
be  remarked  in  passing  that  there  is  absolutely  no  rela- 
tion between  complexion  or  skull  shape  and  intelligence. 
We  have  wonderfully  high  types  of  man  of  every  con- 
ceivable complexion  and  every  head  form.  It  is  only 
where  we  take  huge  numbers  and  compare  types  that  we 
find  the  average  of  the  blond  type  of  white  men  to  be 
so  much  more  intelligent  than  all  others  as  to  have  been 
the  ruling  element  in  Europe  since  historic  times,  and 
even  long  before."  ••  He  advocates  a  theory  propounded 
by  Schmaedel  at  Munich  in  1895.  The  theory  main- 
tains that  there  is  a  definite  relation  between  the  distribu- 


i  ' 


168      HEALTH  AND  SOCIAL  PROGRESS 

tion  of  light  and  color  of  man  and  animals.    If  we  dis- 
tinguish in  the  sun's  rays  those  of  heat,  light,  and  actinic 
power,  we  find  that  coloration  is  intended  to  protect  the 
organism  against  the  dangerous  short  rays,  also  called 
actinic  and  ultra-violet,  because  these  have  the  power  to 
destroy  protoplasm  and  to  obstruct  metabolism.      The 
coloring  is,  consequently,  in  proportion  to  the  amount  of 
light— dark,  brown,  brunette,  blond;  and  he  claims  that 
the  human  races  are  distributed  according  to  this  principle 
—the  dark  races  living  in  the  tropics  where  the  sun  rays 
are  direct  and  burning;  the  brown  in  the  sub-tropics 
where  they  are  pretty  direct,  and  in  the  arctics  where 
light  is  strong  by  reflection;  brunette  in  the  lower  lati- 
tudes of  the  temperate  zones;  and  blond  in  the  higher 
latitudes,  provided   there   is   sufficient  protection   from 
the  light  by  forests,  moisture  or  other  agencies.     The 
"evolution  of  blondness  required,  then,  a  cold,  dark, 
northern    country— probably    a    cloudy,    rainy,    misty, 
forest    country— the   exact   conditions    needed    for    the 
evolution   of   the   brain   by   natural   selection   and   the 
exact    conditions    of    the    countries    where    we    have 
placed  the  origin   of   the  Aryan  or  Teuton.     What  a 
strange  outcome  that  these  three  words  should  become 
synonyms— Aryan— Teuton— Blond."  >»<>    The  law  is  de- 
duced that  "  the  blondness  of  a  European  nation  is  pro- 
portional to  the  cloudiness  of  its  country."  "»    The  Baltic 
people  spread  from  their  original  home  in  different  direc- 
tions and  were  the  originators  of  all  civilizations,  e.g., 
Greek,  Roman,  even  Egyptian  and  others;  since  other 
races  could  develop  civilizations  only  to  a  certain  degree, 
and  needed  the  contact  with  and  guidance  of  the  brainy 
blonds  to  rise  higher.    But  in  each  case  they  died  sooner 
or  later,  because  they  had  wandered  out  of  their  zoologi- 
cal zone. 


HEALTH  AND  WORLD-PROGRESS        169 

This  is  the  briefest  possible  statement  of  Major  Wood- 
ruff's theory.  In  criticism  I  should  like  to  offer  the  fol- 
lowing considerations. 

In  the  first  place.  Woodruff  admits  the  existence  of 
high  intelligence  among  other  peoples  than  blonds,  as  is 
evident  from  his  own  quotation  given  above.  Teutonism 
or  blondness  is,  therefore,  not  responsible  for  intelligence. 
In  the  second  place,  the  severe  struggle  for  existence  does 
not  necessarily  evolve  high  brain  power,  as  Woodruff 
constantly  maintains,  else  this  ought  to  have  developed 
elsewhere  under  similar  conditions.  In  order  to  show 
how  emphatic  he  is  on  this  point,  one  quotation  may  be 
given  from  his  later  work  on  Expansion  of  Races,  "  Cold 
and  severe  climates  are  the  best  for  this  evolution  (of 
the  nervous  system),  because  they  cause  a  more  intense 
struggle  for  existence,  and  the  survival  of  the  fittest 
is  here  the  survival  of  the  most  active  and  intelli- 
gent, just  as  in  the  terribly  severe  glacial  times  only 
the  most  intelligent  survived,  and  there  occurred  a 
rapid  evolution  of  brain."  "^  That  this  struggle  should 
have  developed  a  high  brain  power  only  in  the  Baltic 
area,  not  elsewhere,  is  imposing  too  much  upon  our 
credulity,  unless  we  fall  back  on  blondness  as  an  addi- 
tional reason — an  argument  rejected  by  himself.  In  the 
third  place,  it  would  be  difficult  to  prove  that  this  race 
of  men  was  the  only  one  to  develop  a  high  type  of  civiliza- 
tion in  historic  times.  How  can,  for  instance,  the  history 
of  Peru  and  of  Mexico  with  their  Incas  and  Aztecs  be 
explained  on  that  theory?  There  was  certainly  no  blond- 
ness of  Teuton  origin  there. 

What  Major  Woodruff's  theory  really  means  is  this. 
The  actinic  rays  are  destructive  of  protoplasm ;  hence  all 
organisms  living  in  light  countries  have  to  protect  them- 
selves against  these  rays  by  graded  pigmentation;  but 


I  .■■ 


170       HEALTH  AND  SOCIAL  PROGRESS 

some  of  these  rays  will  always  penetrate  the  skin  not- 
withstanding, coloration,  and  a  high  vitality  is,  conse- 
quently, impossible ;  the  permanent  necessity  of  avoiding 
the  direct  or  reflected  light  makes,  moreover,  continuous 
work  and  with  it  civilization,  impossible.  Thus  stated — 
and  it  seems  to  me  the  only  logical  interpretation— his 
theory  reduces  itself  to  a  question  of  health.  Whether 
the  actinic  rays  have  the  injurious  influence  ascribed  to 
them,  is,  of  course,  another  question;  the  evidence  pro 
and  con  not  being  sufficient  to  decide  the  matter.  Major 
Woodruff's  proofs  taken  from  the  decadence  of  blonds 
in  southern  climates  and  in  light  northern  countries  like 
Colorado  are  susceptible  of  a  different  interpretation,  as 
we  shall  see  later ;  and  the  experiments  carried  on  in  the 
Philippine  Islands  are  insufficient  both  as  to  number  of 
men  and  length  of  time,  to  confirm  or  to  refute  the  actinic 
theory.  It  may  be  well  to  quote  the  conclusion  of  the 
commission  appointed  to  investigate  this  problem.  After 
stating  the  number  of  men  under  observation— 500  blond 
and  500  brunette  soldiers  with  at  least  20  months'  service, 
and  568  officers  of  Philippine  Scouts,  Constabulary,  and 
Manila  police  force,  with  an  average  of  5.5  years'  con- 
tinuous tropical  service— the  results  are  stated  under  five 
heads :  relative  amount  of  sickness,  symptomatology  and 
dietetic  habits,  invalidism  to  United  States,  character  and 
behavior,  and  relative  frequency  of  insolation. 

"  General  summary.  It  is  well  known  that  heat  and 
humidity  in  an  experimental  chamber,  and  in  the  absence 
of  light,  can  produce  symptoms  similar  to  those  occur- 
ring in  a  milder  degree  among  residents  of  the  tropics. 
We  think  it  probable  that  these  two  factors,  combined 
with  infections,  nostalgia  and  monotony,  account  for  most 
if  not  all  of  the  injurious  effects  seen  in  tropical  lands. 
To  explain  the  conditions  met  with  in  the  Philippines 


HEALTH  AND  WORLD-PROGRESS        171 

there  seems  to  be  no  need  for  invoking  the  aid  of  the 
actinic  rays  of  the  solar  spectrum.  Protection  against 
these  rays  by  orange-red  clothing  was  found  to  be  of  no 
benefit.  It  is  by  no  means  proved  that  pigmentation  per 
se  is  beneficial  in  the  tropics.  In  our  investigation  of 
blonds  and  brunettes  the  evidence  was  conflicting,  some 
facts  being  in  favor  of  the  fair  and  others  in  favor  of 
the  dark-complexioned  men.  This  is  what  would  be 
expected  if  there  were  actually  no  difference  between  the 
two  types  as  regards  their  resistance  to  tropical  influences. 
From  a  consideration  of  all  the  data  it  appears  that 
blonds  are  quite  as  well  able  as  brunettes  to  withstand 
the  influences  of  the  Philippine  climate  for  a  period  of 
two  years  and  probably  for  a  period  of  five  and  one-half 
years.  In  case  of  residence  beyond  the  latter  period  we 
are  not  in  a  position  to  express  an  opinion  based  on  ex- 
tensive personal  observation."  ^°^  In  his  refutation  of 
this  criticism  Major  Woodruff  calls  attention  to  the  fact 
that  he  had  advised  brown  and  not  orange-red  clothing 
as  a  protection  against  actinic  rays,  dwells  on  the  admitted 
inadequacy  of  the  experiments  particularly  as  to  time, 
and  refers  to  the  invalidism  of  the  commissioners  them- 
selves shortly  after  having  signed  the  report.^^ 

The  final  objection  to  the  actinic  theory,  or  rather  to 
the  application  which  Woodruff  makes  of  his  theory, 
may  be  stated  as  follows :  If  true,  then  civilizations  of  the 
past  were  always  the  resultant  of  the  forces  of  decay  and 
degeneration;  and  civilization  would  always  depend  on 
the  men  from  the  Baltic  region,  and  could  never  spread 
far  beyond  that  region  for  any  length  of  time.  True, 
he  admits  that  the  source  of  stalwart  men  from  that 
region  will  never  cease  flowing,  and  civilization  is  there- 
fore not  in  danger  of  ever  disappearing.  But  what  would 
happen  if  the  climate  of  the  Baltic  region  should  change 


172      HEALTH  AND  SOCIAL  PROGRESS 

as  that  of  Iceland  has  done  within  recent  years?    This 
may  be  a  groundless  fear,  but  it  should  nevertheless  be 
taken  into  consideration.     Whether  every  civilization  is 
the  result  of  decay  is  an  entirely  different  question,  which 
will  be  discussed  more  fully  later.    Suffice  it  to  say  here 
that  Woodruff  is  fully  convinced  of  that  fact.     "  His- 
torians are  now  pretty  well  agreed  that  at  the  period  of 
the  greatest  literary  glory  of  Greece,  500  B.C.,  the  deca- 
dence of  the  Greeks  was  already  evident,  and  it  is  even 
said  that  it  was  complete.    It  is  possible  for  such  neurotics 
to  be  possessed  of  great  literary,  artistic,  or  military  skill, 
as  at  the  present  day,  and  the  decadence  of  the  Greeks 
was  probably  the  cause  of  their  art.    A  wonderful  con- 
firmation of  this  view  is  afforded  by  a  study  of  ancient 
Greek  statuary  which  faithfully  copies  the  stigmata  of 
degeneration  found  in  modem  degenerates,  just  as  though 
their  best  models  from  the  aristocracy  were  defective. 
A  famous  head  of  Juno  has  arrested  development  of  the 
lower  jaw  of  marked  degree  and  is  the  head  of  a  dying 
race.    It  confirms  what  we  know  from  all  sources,  that 
the  climate  of  Greece,  practically  in  the  latitude  of  Mary- 
land,  required  but   seven  centuries,  or  thereabouts  to 
destroy  its  blonds."  ^^^ 

Since  Major  Woodruff  does  not  quote  any  historians 
to  support  his  claim,  it  is  rather  difficult  to  find  out  who 
they  are.  One  historian  may  be  quoted,  though,  to  show 
that  Greek  degeneracy  began  later  than  500  b.c. 
Mahaffy,  in  speaking  of  the  numerous  plots  and  revolu- 
tions started  by  exiled  Greeks  in  their  native  city-states, 
ends  the  discussion  with  these  words :  "  These  scenes  of 
violence  play  so  large  a  part  in  our  Greek  histories  that 
you  will  wonder  how  any  such  people  could  be  a  model 
to  others  in  methods  of  politics,  and  it  is  for  that  reason 
that  I  think  it  necessary  to  notice  the  matter.     When 


HEALTH  AND  WORLD-PROGRESS       173 

we  look  below  the  surface  we  shall  find  that  there  were 
elements  of  order  never  eradicated,  and  that  the  crimes 
of  the  leaders  of  society  did  not  infect  the  common  sense, 
or  destroy  the  safety  of  the  mass  of  people,  until  the 
general  decadence  in  the  days  of  Polybius  and  the  Roman 
interference."  *<»•  This  happened  fully  three  centuries 
later,  since  Polybius  was  born  204  and  died  123  B.C. 

In  regard  to  the  degeneracy  of  the  famous  Juno,  no 
date  is  given,  and  it  is  consequently  impossible  to  decide 
whether  it  is  from  the  fourth  or  second  century  B.C. 
or  even  later.  The  degeneracy  of  Socrates,  Antisthenes, 
and  Diogenes — even  if  real — need  not  be  an  indication  of 
Greek  decadence,  since  no  one  would  judge  Germany  of 
today  by  Nietzsche,  or  England  by  Oscar  Wilde.  The 
men  who  fought  at  Marathon,  Thermopylae,  and  Salamis 
were  certainly  not  degenerates,  but  men  of  high  physical 
and  mental  attainments.  In  a  previous  chapter,  specific 
and  sufficient  reasons  have  been  given  for  the  decadence 
of  Greece,  even  granting  now  that  these  men  were  of  the 
blond  Baltic  type  as  Major  Woodruff  claims. 

This  is,  however,  not  by  any  means  certain,  since  Ripley 
is  of  a  different  opinion.  Speaking  of  the  one  hundred  or 
more  well-authenticated  crania  left  to  us,  he  says :  "  The 
testimony  of  these  ancient  Greek  crania  is  perfectly  har- 
monious. All  authorities  agree  that  the  ancient  Hellenes 
were  decidedly  long-headed,  betraying  in  this  respect  their 
affinity  to  the  Mediterranean  race,  which  we  have  already 
traced  throughout  Southern  Europe  and  Africa. — As  we 
shall  see,  every  characteristic  in  their  modern  descendants 
and  every  analogy  with  the  neighboring  populations,  lead 
us  to  the  conclusion  that  the  classical  Hellenes  were  dis- 
tinctly of  the  Mediterranean  racial  type,  little  different 
from  the  Phoenicians,  the  Romans,  or  the  Iberians."  *«^ 
One  more  statement  should  be  made  before  proceeding 


\^^b 


174       HEALTH  AND  SOCIAL  PROGRESS 

to  our  own  theory.    The  effects  of  heat  and  hun.idity,  if. 
coincident,  are  disastrous;  one   without  the  other  not 
nearly  so.    As  illustrations  we  may  cite  the  dry  heat  of 
some  deserts  where,  notwithstanding  a  high  temperature, 
people  are  healthy,  e.g.,  some  parts  of  the  Sahara  and 
of  Arabia ;  while  the  west  coast  of  Ireland,  the  lake  re- 
gions of  England,  and  the  northwestern  coast  of  the 
United  States  are  likewise  healthy,  although  they  are 
rather  wet.     It  is  excessive  heat,  together  with  great 
humidity,   that   forms  a   most  deadly  combination   for 
people  not  acclimated  to  it,  as  the  mortality  on  the  west 
coast  of   Africa   proves.     This   mortality   is   generally 
ascribed  to  climate,  or  more  particularly  to  the  combina- 
tion of  heat  and  humidity.    But  it  seems  that  a  different 
interpretation  is  possible.     If  heat  without  humidity  is 
not  necessarily  injurious,  nor  humidity  without  heat,  the 
combination  is  deadly  because  it  is  only  in  such  a  medium 
that  certain  disease  germs  can  live.     Neither  the  para- 
sites of  malaria  nor  those  of  uncinariasis  can  live  without 
both  heat  and  moisture;  hence  people  living  in  places 
where  either  of  these  features  is  absent,  are  healthy  and 
strong,  other  conditions  being  equal.    It  is,  therefore,  not 
so  much  the  combination  that  seems  to  be  disastrous  to 
man,  as  the  fact  that  it  provides  the  necessary  conditions 
for  the  growth  of  these  parasites ;  and  if  man  can  protect 
himself  against  them — as  he  is  now  able  to  do — the  pros- 
pects of  even  these  most  deadly  regions  becoming  in- 
habitable to  people  from  higher  latitudes,  seem  at  least 
fairly  bright.    As  an  illustration  of  what  can  be  done,  yel- 
low fever  may  be  cited.    This  disease  was  for  a  long  time 
considered  to  be  due  to  climate,  because  it  occurred  chiefly 
in  the  tropics.    But  since  the  demonstration  in  1900  by 
Major  Walter  Reed,  of  the  United  States  Army,  showing 
that  the  mosquito  stegomyia  is  the  carrier  of  the  yellow 


HEALTH  AND  WORLD-PROGRESS       175 

fever  parasite,  and  the  cleaning  of  Havana  by  Colonel 
Waring,  we  have  come  to  the  conclusion  that  it  is  amen- 
able to  treatment  by  human  beings,  and  its  eradication  by 
all  civilized  communities  has  proved  once  more  the  spe- 
ciousness  of  reasoning  which  vaguely  attributes  certain 
effects  to  climate  instead  of  to  specific  causes.  As  long  as 
persons  wander  into  the  tropics  and  are  stupid  enough  to 
expose  themselves  to  a  hot,  glaring  sun  while  the  natives 
shun  and  avoid  all  work  during  the  hours  of  noon,  they 
are  like  the  proverbial  man  who  doesn't  know  enough  to 
get  out  of  the  rain;  since  exposure  of  that  kind  is  equal 
to  the  folly  of  trying  to  sleep  outdoors  in  the  Adirondacks 
during  the  winter — unless  one  be  specially  protected.  It 
may  not  kill,  but  it  is  certainly  injurious.  In  looking  for 
causes  of  breakdowns  in  the  tropics,  individual  and  social 
habits  are  as  often  responsible  as  certain  diseases ;  the  two 
combined  will  explain  the  vast  majority  of  physical  and 
mental  breakdowns ;  and  the  "  climate,"  if  given  as  a 
cause,  should  be  reduced  to  specific  terms,  or  not  men- 
tioned at  all.  Man  is  sufficiently  inclined,  as  it  is,  to  shift 
responsibility;  and  the  climate  has  served  in  too  many 
cases  as  an  excuse  for  individual  predisposition  and  in- 
clination to  evil.  Only  by  looking  for  specific  causes 
will  it  be  possible  to  determine  whether  the  tropics  and 
sub-tropics  are  habitable  for  white  men.  "  The  question 
as  to  the  ability  of  races  to  thrive  under  conditions  of 
temperature  other  than  those  of  their  ancestors  is  one 
which  has  received  considerable  attention.  It  has  long 
been  held  that  the  tropics  could  never  become  a  field  of 
conquest  for  the  nations  of  the  temperate  zones,  since 
the  climate  rendered  occupation  by  them  impossible.  Not- 
withstanding the  fact  that  distinguished  observers  main- 
tain this,  experience  seems  to  demonstrate  that  acclima- 
tization depends  very  largely  upon  a  rigid  observance  of 


TtBT 


;!n; 


176       HEALTH  AND  SOCIAL  PROGRESS 

sanitary  and  hygienic  rules,  and  many  places  which  were 
once  considered  fatal  to  the  white  man  are  being  proved 
comparatively  healthful.  When  we  consider  that  they 
have  lost  their  bad  name  solely  by  an  exercise  of  local  and 
personal  hygiene,  we  must  not  despair  of  the  power  of 
man  to  reduce  the  unhealthfulness  of  even  large  areas  in 
tropical  climates."  "® 

In  order  to  illustrate  from  another  point  of  view  how 
necessary  it  is  to  look  for  specific  instead  of  general 
reasons,  we  will  refer  to  geophagy  or  dirt-eating.  Deni- 
ker  ^®*  states  that  the  custom  is  widespread,  occurring  in 
Senegal,  Persia,  especially  the  Asiatic  Archipelago,  India, 
South  America,  Java ;  and  gives  as  reasons  the  desire  for 
a  beautiful  complexion,  and  the  necessity  of  supplying 
the  deficiency  of  mineral  substances  among  vegetarian 
nations.  It  does  not  seem  to  have  occurred  to  him  that 
in  all  of  the  countries  mentioned,  uncinariasis  is  very 
prevalent,  and  may  possibly  be  a  cause  of  geophagy. 
Reading  of  the  "  sand-lappers  "  in  South  Carolina  being 
hookworm  victims,  I  wrote  Dr.  Charles  W.  Stiles  asking 
whether  this  custom  was  not  a  result  rather  than  a  cause 
of  the  disease.  In  reply  he  states  that  it  seems  quite  clear 
to  him  that  dirt-eating  is  a  result,  and  not  the  cause  of  the 
infection  with  hookworm;  and  refers  to  the  fact  that 
this  habit  is  known  to  occur  among  elephants,  dogs,  and 
sheep  when  infested  with  various  intestinal  parasites. 

It  may  be  well  to  say  a  few  words  in  conclusion.  It 
has  not  been  our  intention  to  deny  the  validity  of  certain 
factors  as  means  to  progress,  but  to  insist  upon  the  state- 
ment of  specific  reasons  instead  of  being  satisfied  with 
attributing  civilization  to  general  causes,  e.g.,  head  form, 
brain  weight,  climate,  or  actinic  rays.  These  factors 
have  undoubtedly  some  influence,  but  they  are  all  beyond 
our  control  at  present,  and  we  are  likely  to  make  little 


HEALTH  AND  WORLD-PROGRESS       177 

headway  as  long  as  we  are  content  to  take  them  as  the 
principal  causes.  If  we  try,  however,  to  look  for  specific 
causes,  and  find  that  they  produce  definite  effects,  we  are 
more  likely  to  attack  certain  problems  in  a  definite  man- 
ner, and  arrive  at  results;  and  that  is  the  only  way  to 
make  progress.  It  may  seem  as  if  we  had  over-empha- 
sized the  importance  of  the  two  diseases  mentioned.  We 
have  stated,  however,  that  they  are  not  the  only  ones, 
for  there  are  many  others  which  infest  the  tropics  and 
sub-tropics.  None  of  these  is,  however,  as  widespread 
or  generally  and  specifically  as  injurious  to  whole  popula- 
tions as  malaria  and  uncinariasis ;  neither  have  they  been 
studied  so  extensively  and  intensively,  nor  have  such 
definite  results  been  attained  in  combating  them  as  with 
these  two.  The  purpose  has  been  throughout  to  call  at- 
tention to  results  both  of  the  disease  and  of  the  cure,  and 
to  show  that  we  can  advance  only  in  this  manner.  Just  as 
I  write  this,  the  daily  papers  report  that  an  interesting 
investigation  is  to  be  made  by  Dr.  E.  L.  Atkinson,  the 
parasitologist  of  the  Scott  Antarctic  Expedition.  He  pur- 
poses to  find  the  parasite  in  the  Yang-tse  River  which 
causes  a  serious,  and  even  deadly,  disease  among  those 
who  work  in  and  about  rivers,  and  if  successful,  to  dis- 
cover a  remedy.  In  view  of  what  has  been  already 
achieved  with  typhoid  and  yellow  fever,  malaria,  hook- 
worm, the  bubonic  plague,  and  other  diseases,  it  is  very 
probable  that  Dr.  Atkinson  will  succeed,  and  we  shall 
have  important  results,  hitherto  attributed  to  cilmate  or 
something  else,  assigned  to  a  specific  cause  with  which 
we  know  how  to  deal.  An  intelligent  society  should  be 
telic ;  that  is,  attack  its  problems  in  a  scientific  and  defin- 
ite manner,  otherwise  it  relapses  into  the  condition  of  the 
semi-civilization  of  Mohametanism  which  charges  its 
shortcomings  to  Allah. 


CHAPTER  XI 

HEALTH  AND  WORLD-PROGRESS  (Continued) 

In  the  last  chapter  an  attempt  was  made  to  explain  the 
inadequacy  of  various  theories  to  account  for  European 
civilization.  It  becomes  necessary  to  present  a  different 
view  which  is  more  in  accord  with  the  facts. 


II.     PROGRESS  EXPLAINED  ON  THE  BASIS  OF  HEALTH 

In  order  to  account  for  progress  on  the  basis  of  health 
it  may  be  advisable  to  keep  in  mind  the  five  laws  stated 
at  the  end  of  the  fifth  chapter.  Briefly  stated,  they  dealt 
with  progress — possible  only  with  surplus  energy;  with 
work — ^possible  only  with  wisely  controlled  energy ;  with 
social  personality — possible  only  through  mutually  help- 
ful and  sympathetic  relations  with  others;  with  civiliza- 
tion— ^possible  only  through  interdependence  of  persons 
and  peoples  resulting  in  exchange  of  mental  and  indus- 
trial products;  with  general  development — possible  only 
through  increased  self-reliance.  In  each  case  we  found 
health  to  be  the  necessary  foundation  for  these  various 
forms  of  expansion.  Civilization  is  in  its  ultimate  es- 
sence a  form  of  expansion,  passing  from  physical  buoy- 
ancy through  intellectual,  emotional,  and  volitional  depth 
and  breadth  to  self-reliance,  and  thus  to  confidence  to  con- 
trol nature  and  man's  destiny.  We  believe  that  these  laws 
will  be  illustrated  directly  or  indirectly  in  the  following 
pages. 

Man  must  have  begun  his  career  as  a  human  being  in 
a  warm  country,  since  such  a  locality  alone  could  furnish 

178 


HEALTH  AND  WORLD-PROGRESS       179 

sufficient  food  to  him  whom  nature  had  failed  to  supply 
with  any  effective  weapons  for  defense  or  offense. 
Whether  this  place  was  near  the  equator  or  near  the 
poles,  and  whether  there  was  only  one  progenitor  or 
several  for  the  various  races,  are  questions  which  do 
not  concern  us.  The  only  problem  which  interests  us  is 
the  relation  of  health  to  progress. 

We  have  seen  that  neither  head  form,  nor  brain  weight 
can  fully  account  for  intelligence — the  only  weapon  which 
man  developed  in  the  course  of  time.  How  did  he  accom- 
plish that?  Wherever  man  had  enough  food  to  generate 
surplus  energy  over  his  immediate  needs,  this  opportunity 
was  provided.  Generally  speaking,  any  tropical  or  sub- 
tropical region  will  furnish  an  abundance  of  coarse  food 
in  the  form  of  fruits,  berries,  roots,  nuts,  and  other 
plants.  There  are  likewise  small  animals  on  land  and  in 
the  sea  which  supply  at  least  occasional  changes  in  the 
regimen  of  vegetable  food.  Man  was  thus  able  to  live 
and  multiply  almost  in  any  warm  climate.  But  while 
food  was  to  be  had  anywhere  in  those  regions,  health  was 
not.  The  very  climate  in  which  it  is  easiest  for  man  to 
subsist,  is  likewise  most  abounding  in  disease  germs  of 
various  kinds.  Manson  enumerates  about  30  diseases  as 
"  tropical  "  in  the  metereological  rather  than  geographical 
sense.  All  other  diseases  may,  of  course,  occur  in  those 
regions ;  e.g.,  in  Porto  Rico  there  are  at  least  one  hundred 
and  fifty-two.  We  have  seen  what  havoc  two  of  these 
diseases  may  work,  and  it  is  easy  to  conjecture  that  life 
in  a  locality  where  practically  every  person  suffers  from 
at  least  one  of  them,  many  from  two — since  uncinariasis 
and  malaria  at  least  may  be  simultaneous — ^must  have 
been  what  Victor  Hugo  describes  in  the  words :  "  It  is 
nothing  to  die ;  but  it  is  frightful  not  to  live,"  that  is,  not 
to  live  healthily,  or  to  live  with  constant  pains  and  ache$. 


180       HEALTH  AND  SOCIAL  PROGRESS 

With  the  vast  majority  of  people  affected  by  disease,  with 
food  coarse,  innutritious,  and  often  irregular — it  was 
practically  impossible  to  store  up  any  surplus  energy  to 
improve  one*s  lot,  for  all  innovations  require  extra  effort, 
and  that  is  impossible  to  those  of  low  vitality.    Man  in 
those  regions  has  made  but  little  advance  to  this  day, 
owing  to  the  permanence  of  tropical  diseases.    A  hook- 
worm or  malaria  victim  may  have  enough  energy  to  toil 
and  slave  for  the  simple  food  he  eats,  when  the  pangs  of 
hunger  drive  him,  but  beyond  that  he  is  unable  to  go, 
simply  because  much  of  the  time  he  must  rest  and  sleep 
from  sheer  weariness.     The  jibaro  of  Porto  Rico  toils 
long  hours  sometimes,  but  in  a  mechanical  way.    The  in- 
habitants of  hot  climates  are,  as  a  rule,  listless,  uninven- 
tive,  apathetic,  and  improvident,  not  so  much  because  of 
the  heat,  against  which  there  is  protection  through  shade, 
but  owing  to  the  various  parasites  which  infest  their  blood 
and  digestive  organs,  from  which  in  lower  civilizations 
there  is  no  escape.    Whatever  energy  is  generated  from 
food,  is  consumed  in  the  performance  of  mere  physiologi- 
cal  functions;  any   possible   surplus  goes   to   feed  the 
myriads  of  parasites,  and  none  is  left  for  activities  which 
make  leaders  and  inventors.     If  by  any  chance  some 
chieftains  or  warriors  escape  the  worst  effects  of  low 
vitality,  owing  to  better  food  and  more  rest,  their  energy 
will  expend  itself  in  acts  of  cruelty  and  vice,  since  the 
balance  of  good  health  is  missing  and  thus  no  control  is 
exercised  over  the  purely  physical  instincts.    No  progress 
is  possible  in  those  regions  where  disease  germs  abound, 
unchecked  by  the  science  of  man. 

We  have  given  the  percentage  of  people  suffering  from 
uncinariasis  in  many  countries.  Malaria  is  spread  over 
even  a  wider  area  of  the  globe,  since  it  extends  farther 
south    and    farther    north,      Th^    so-called,    "deadly 


HEALTH  AND  WORLD-PROGRESS       181 

climates  "  always  mean  malarious  countries.     And  this 
disease  parallels  anchylostomiasis  in  its  power  to  make 
people  anaemic,  since  the  malaria  parasites  attack  the  red 
corpuscles  and  cause  a  reduction  of  hemoglobin,  of  the 
latter,  often  by  40  per  cent  in  a  few  days  and  of  the 
former  by  60  or  even  80  per  cent.     It  stands  to  reason 
that  where  the  whole  population  is  afflicted  with  even 
one  of  the  numerous  tropical  diseases,  no  energy  is  left 
for  any  but  the  absolutely  necessary  activities — physio- 
logical   functions    imperatively    demanding   satisfaction. 
Every  inhabitant  of  those  regions  is  in  a  pathologic  con- 
dition owing  to  one  or  another  disease  peculiar  to  the 
country.    Even  slight  affections  are  not  without  signifi- 
cance ;  for,  in  a  stock  of  low  vitality,  attacked  by  malaria 
in  childhood  and  by  uncinariasis  after  puberty,  but  little 
is  needed  to  shake  the  constitution  to  its  very  founda- 
tions.   While  mortality  from  malaria  is  estimated  to  be 
only  1,130,000  in  an  ordinary  year  all  over  the  world,  this 
number  represents  an  enormous  amount  of  suffering  and 
loss  of  labor,  often  when  the  latter  is  most  valuable. 
The  aftermath  is  frightful,  since  the  drain  on  the  consti- 
tution is  heavy,  and  various  other  diseases,  e.g.,  neuras- 
thenia, vascular  or  cardiac  troubles,  find  ready  victims 
owing  to  the  excessive  calls  on  the  energy  of  these  organs 
due  to  the  exhaustion  of  the  whole  body.    As  a  result  of 
the  poor  quality  and  large  quantity  of  coarse,  bulky,  in- 
nutritious  food,  many,  if  not  the  majority  of  people  in  the 
tropics  and  sub-tropics  are  in  a  state  of  chronic  starva- 
tion.   They  live,  consequently,  on  the  borderland  between 
health  and  disease,  and  a  number  of  parasites  of  any 
disease  may  prove  the  last  straw  to  break  the  camel's 
back.    And  the  chronic  character  of  these  diseases  permits 
hardly  anyone  to  escape.  How  can  any  surplus  energy 
be  generated  under  these  condition??    They  are  a  mo?t 


182      HEALTH  AND  SOCIAL  PROGRESS 

miserable  people.  "  The  dwellers  in  a  malarious  region 
like  the  Terai  at  the  foot  of  the  (Himalayas)  are  miser- 
able, listless,  and  ugly,  with  large  heads  and  particularly 
prominent  ears,  fiat  noses,  tumid  bellies,  slender  limbs 
and  sallow  complexions;  the  children  are  impregnated 
with  malaria  from  their  birth,  and  their  growth  is  at- 
tended with  aberrations  from  the  normal  which  prac- 
tically amount  to  the  disease  of  the  rickets.  The  malarial 
cachexia  that  follows  definite  attacks  of  ague  consists  in 
a  state  of  ill-defined  suffering,  associated  with  a  sallow 
skin,  enlarged  spleen  and  liver,  and  sometimes  with 
dropsy."  ^"  H  as  many  as  60  to  80  per  cent  of  the  popu- 
lation are  victims  of  malaria,  and  about  75  per  cent  of 
uncinariasis — equally  disastrous  in  its  consequences — it  is 
not  difficult  to  see  that  such  a  people  cannot  generate 
sufficient  energy  for  any  but  the  absolutely  necessary  ac- 
tivities for  sustenance.  So  miserable  is  the  condition  of 
most  people  in  warm  climates  that  intoxicants  and  nar- 
cotics are  generally  resorted  to  to  find  a  little  relief  from 
the  continuous  feeling  of  depression  and  lethargy.  This  is 
most  probably  the  explanation  of  the  almost  universal 
use  of  artificial  stimulants,  especially  when  we  find  that 
those  of  low  vitality  among  civilized  peoples  resort  almost 
without  exception  to  some  kind  of  exhilarating  drink  or 
drug. 

The  condition  of  all  countries  in  the  tropics  and  sub- 
tropics  has  been  similar  to  the  one  described  in  the  case  of 
Porto  Rico,  with  variations  in  some  localities  for  better, 
in  others  for  worse.  The  debilitating  influences  of  en- 
demic diseases  have  played  an  incalculable  part  in  the 
history  of  all  warm  countries.  The  present  condition  of 
southern  and  central  China,  India,  Central  America,  and 
very  large  parts  of  South  America,  the  West  Indies, 
practically  of  all  Africa  and  other  parts  of  the  tropics  and 


HEALTH  AND  WORLD-PROGRESS       183 

sub-tropics,  is  accounted  for  to  a  large  extent  by  the 
ravages  of  these  diseases,  unchecked  for  many  centuries, 
and  therefore  cumulative  in  their  effects  on  succeeding 
generations.  If  even  in  the  Southern  States  of  the  Union 
with  their  numerous  healthy  localities,  the  subjects  of 
malaria  and  hookworm  are  almost  branded  by  their  ap- 
pearance and  low  social  character  as  beings  of  a  dif- 
ferent race,  the  results  in  a  generally  lower  civilization, 
with  worse  sanitary  conditions,  must  have  been  much 
worse.  Men  cannot  live  generation  after  generation  on 
a  low  vitality  plane  without  physical,  mental,  moral,  and 
social  deterioration.  People  whose  amount  of  energy  is 
so  small  that  they  cannot  perform  any  but  the  most  neqes- 
sary  activities,  and  these  only  by  forcing  themselves  be- 
cause of  constant  aches  and  pains,  soon  become  self- 
centered  and  unsocial,  lose  control  over  themselves  and 
with  it  self-respect  and  moral  sense.  Their  attitude  is 
one  of  carelessness,  listlessness,  and  general  apathy.  The 
indulgence  of  the  physical  appetites  is  their  only  concern, 
since  the  nervous  system  is  disintegrated,  and  the  in- 
stincts are  no  longer  under  the  control  of  a  well-balanced, 
healthy  constitution. 

We  have  an  analogy  here  to  what  happens  in  old  age 
with  the  breaking  up  of  the  nervous  and  digestive  sys- 
tems. Because  of  the  lowering  of  vitality  many  old 
people  become  pessimistic,  irritable,  contentious,  and 
even  moral  perverts.  The  control  of  the  whole  over  the 
parts  is  lacking,  and  small  incidents  will  disturb  whatever 
balancing  elements  are  left.  Under  these  conditions  wild 
ideas  easily  find  admission.  A  healthy  man  has  a  stand- 
ard in  his  own  ability  of  performance  for  whatever  can 
be  done,  and  is  therefore  in  a  position  to  judge  the  per- 
formances of  others.  If  anyone  promises  too  much  or  any- 
thing that  passes  the  range  of  his  comprehension,  he  will 


184      HEALTH  AND  SOCIAL  PROGRESS 

become  cautious  and  skeptical.  It  is  difficult  to  deceive 
him  more  than  once.  The  sick  man  has  his  fancies,  and 
in  acute  cases,  his  delirium,  just  because  the  diseased 
part  no  longer  serves  the  whole  in  an  unobtrusive  and 
effective  manner,  but  asserts  itself  and  throws  the  entire 
system  out  of  order.  What  happens,  however,  in  his  case 
in  an  acute  form,  happens  in  that  of  devitalized  persons 
constantly  in  a  milder  degree.  The  one  desire  is  for  a 
feeling  of  buoyancy  and  well-being  which  they  have  ex- 
perienced in  the  few  moments  of  occasional  relief.  Ow- 
ing to  their  inability  to  measure  performance  on  account 
of  their  own  defects,  they  readily  accept  promises  of 
help  and  relief,  no  matter  how  fanciful.  The  psychology 
of  patent  medicine  vendors  and  consumers  is  based  on 
this  principle.  The  vendor  knows  that  those  ailing  from 
some  trouble  can  easily  be  induced  to  believe  their  diffi- 
culty to  be  greater  than  it  is;  and  so  he  works  up  a 
description  of  symptoms  which  is  certain  to  tally  with 
some  of  the  patients*  feeHngs.  The  consumer,  already 
off  his  guard  through  the  general  tendency  of  illness  to 
deprive  one  of  a  proper  sense  of  proportion,  becomes 
alarmed,  believes,  and  buys.  In  a  population  where  prac- 
tically everybody  lives  on  a  low  vitality  plane  and  where 
many  are  actually  sick,  there  is  no  general  standard  for 
the  performance  of  the  possible,  and  superstition,  cre- 
dulity, and  a  general  lack  of  estimating  promises  at  their 
true  value,  are  the  result.  The  pessimism  of  old  age, 
too,  can  be  explained  on  this  principle.  Power  to  per- 
form is  in  a  large  measure  gone,  and  there  is  just  enough 
energy  left  to  resent  this  inability.  But  man  cannot  live 
in  a  resentful  mood  for  a  long  time  without  changing  the 
tone  of  his  whole  attitude.  For  a  time  he  may  be  satis- 
fied in  speaking  about  the  superior  performances  of  his 
younger  days.    This  soon  becomes  tiresome,  and  inability 


HEALTH  AND  WORLD-PROGRESS       185 

to  act  effectively  creates  a  feeling  of  distrust  in  the  value 
of  one's  own  actions  in  the  course  of  time.  The  final 
result  is  pessimism  or  perhaps  superstition,  even  in  as 
brilliant  a  man  as  the  late  Alfred  R.  Wallace  in  his  old 
age.    Lombroso  is  another  case  in  point. 

The  application  of  this  general  principle  is  not  far  to 
seek.  The  connection  of  endemic  diseases  and  of  Nir- 
vana was  hinted  at  in  the  last  chapter.  This  may  have 
seemed  fanciful,  but  on  the  basis  of  the  principle  just 
stated,  it  appears  less  so.  Where  every  possible  means  to 
rid  oneself  of  continuous  suffering  has  failed,  and  where 
misery  is  the  one  permanent  and  universal  element  in 
the  social  environment,  the  whole  of  individual  existence 
comes  to  be  regarded  as  consisting  of  pain,  and  the 
annihilation  of  individuality  or  the  ceasing  of  activity  in 
Nirvana  must  appear  as  the  only  way  of  solving  the 
problem.  The  average  Hindoo,  not  being  sufficiently 
educated  to  comprehend  such  a  doctrine,  just  as  naturally 
resorts  to  various  superstitions  as  means  of  relief;  and 
the  numerous  practices  of  the  most  revolting  character  in 
the  religions  of  India  amply  testify  to  what  depth  of 
degradation  a  people  can  descend  when  constant  physi- 
cal suffering,  even  in  a  mild  degree,  perverts  the  whole 
mental  attitude  toward  seeking  relief  at  any  cost.  The 
voodooism  of  the  Porto  Rican  negro  was  referred  to  as 
due  to  a  similar  source.  In  short,  it  seems  to  me,  tfiat 
many  superstitions  in  religion  and  other  departments  of 
life  originated  in  a  feeling  of  inability  to  perform,  and 
in  the  consequent  absence  of  a  personal  measure  for  the 
value  of  promise  to  perform.  But  the  whole  of  the  tropi- 
cal and  of  the  ancient  world  has  been  subjected  to  this 
inability  owing  to  the  practically  general  occurrence  of 
endemics  and  frequent  epidemics;  hence  all  of  the  re- 
ligions originating  there  are  not  only  full  of  superstitions, 


I 

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186       HEALTH  AND  SOCIAL  PROGRESS 

but  express  above  all  else  the  ardent  desire  for  relief 
from  suffering. 

The  principle  stated  may  be  applied  also  in  the  political 
realm.  The  civilized  world  is  informed  almost  every 
year  about  a  revolution  in  one  of  our  Central  and  South 
American  republics.  These  people  have  what  the  politi- 
cians and  statesmen  always  talk  about — free  institutions, 
liberal  constitutions,  and  for  the  minority,  at  least,  a  fair 
system  of  education.  Yet,  it  is  the  most  educated  in  those 
countries  who  are  plotting  and  counter-plotting,  and  each 
new  aspirant  for  presidential  honors  readily  finds  ad- 
herents. How  does  he  get  them?  By  promises  of  vari- 
ous kinds,  all  of  which  are  plainly  Utopian.  Yet,  to  the 
peon  of  Mexico,  or  of  the  different  republics  of  Central 
and  South  America,  they  seem  credible  because  he  has 
never  performed  systematic  work  in  his  life  and  has, 
thus,  no  standard  to  measure  the  promises  of  others  in 
regard  to  the  possibility  of  performance.  And  why  can 
he  not  work?  Because  he  is  born  with  a  weak  constitu- 
tion, gets  malaria  during  his  childhood,  has  uncinariasis 
in  his  youth,  and  never  has  an  opportunity  to  lay  up  any 
surplus  energy.  Hence  any  demagogue  who  is  shrewd 
enough  to  make  his  promises  sufficiently  glowing,  has  no 
difficulty  in  finding  adherents,  although  the  least  modicum 
of  common  sense  and  the  oft-repeated  impossibility  of 
keeping  said  promises  ought  to  teach  these  people  that 
any  plans  proposed  by  the  most  fervid  orator  are  but  so 
many  idle  words,  spoken  to  enthrall  the  fancy  of  a 
multitude  incapable  of  thinking,  because  bent  only  on  re- 
lief from  an  intolerable  condition.  A  blind  belief  in 
promises  of  any  kind  has  taken  the  place  of  clear  think- 
ing, and  the  demagogue  appeals  to  this  desire  for  libera- 
tion from  suffering.  The  present  political  and  economic 
condition  of  some  parts  of  Europe  furnishes  a  recent 


HEALTH  AND  WORLD-PROGRESS       187 

illustration  of  the  same  principle.  Lack  of  food  during 
the  World  War  produced  widespread  devitalization.  The 
result  is  a  belief  in  all  kinds  of  vagaries,  especially  in 
Russia  where  conditions  were  worst.  These  people  have 
lost  optimism  and  self-control. 

Whichever  way  we  turn,  then,  the  phenomenon  of  low 
vitality  in  the  warm  climates,  due  chiefly  to  endemic 
diseases,  confronts  us  with  its  retardation  of  progress, 
lack  of  initiative,  and  absence  of  clear  thinking.  For 
whatever  the  ultimate  explanation  may  be,  the  primary 
fact  remains  that  the  phenomena  of  consciousness  are 
inextricably  involved  with  physiological  conditions; 
they  are  exalted  or  depressed  with  the  latter;  they  un- 
fold and  flourish  with  the  health  and  vigor  of  the  organ- 
ism; and  decline  or  fade  away  with  the  deterioration  of 
the  body.  The  human  body  is  an  engine  for  the  con- 
version of  food  into  energy.  In  proportion  as  the  engine 
is  supplied  with  good  fuel  and  is  kept  free  from  friction, 
will  the  energy  be  greater  and  expended  more  economi- 
cally. 

In  the  warm  climates  the  food  is  generally  poor  and 
the  friction  in  the  organism  is  great  and  incessant,  owing 
to  parasites;  hence  no  surplus  power  can  be  generated, 
and,  inferentially  at  least,  no  high  mentality  can  be 
created.  The  result  is  stagnation  within  and  retardation 
of  civilization  introduced  from  without. 

Mexico  will  serve  as  a  good  illustration  of  this  con- 
dition of  things.  It  is  the  treasure  vault  of  the  globe, 
not  only  by  virtue  of  its  mineral  wealth  but  by  its  agri- 
cultural potentialities.  But  though  Mexico  is  rich,  Mexi- 
cans are  very  poor;  they  can,  moreover,  never  be  rich 
unless  the  conditions  of  health  are  changed  among  the 
peons.  When  the  vast  majority  of  a  people  is  under  the 
influence  of   debilitating  diseases — and   Mexico  has  a 


I 


188      HEALTH  AND  SOCIAL  PROGRESS 

large  amount  of  malaria  and  uncinariasis  beside  many 
others — persistent  work  is  out  of  the  question,  and  work 
alone  will  bring  wealth  to  a  country.  These  people  are 
without  energy,  merely  doing  enough  to  meet  their  few 
elementary  needs.     When  aroused  into  some   kind  of 
frenzy,  as  is  apt  to  be  the  case  with  mentally  poorly 
balanced  people,  they  become  cruel  and  irresponsible. 
The  world  has  been  shocked  many  times  by  savage  acts 
of  cruelty  on  the  part  of  soldiers  and  officers.    The  revo- 
lutionists shoot  down  the  defenders  of  any  established 
government  in  cold  blood,  and  any  revolutionist  is  treated 
as  a  traitor.     It  is  better  to  die  on  the  field  of  battle 
than  to  become  a  prisoner,  since  massacre  of  prisoners 
goes  on  from  decade  to  decade.    Having  a  poorly  bal- 
anced nervous  system  owing  to  poor  food  and  internal 
parasites,  the  peon  can  be  stirred  only  by  the  promise 
of  the  satisfaction  of  his  elemental  passions  for  loot,  re- 
venge, and  violence.    These  are  easily  aroused  and  the 
leaders  see  to  it  that  they  are  satisfied;  and  any  bandit 
making  promises  in  this  manner  will  find  ready  followers. 
When  not  aroused  the  peon  is  about  as  lazy  and  inactive 
a  being  as  physiological  necessities  permit  him  to  be. 
This  may  explain  why  Porfirio  Diaz  created  a  most  ef- 
ficient corps  of  rurales  from  bandits  and  leaders  of  rob- 
ber bands.     These  men  had  shown  at  least   sufficient 
energy  to  be  bad,  while  the  average  peon  merely  gave 
evidence  of  an  unconquerable  desire  to  eat,  drink,  and 
sleep,  perhaps  to  loaf  when  not  too  tired.    Only  a  hope- 
lessly devitalized  people  would  permit  a  government  such 
as  Mexico  has  had — ^a  handful  of  Spaniards  in  alliance 
with  a  small  section  of  the  mixed  race  has  held  all  the 
offices  in  the  courts,  army,  and  administration.    And  not 
once  have  the  lower  strata  of  the  population  risen  in 
revolt  against  this  small  dan.    Revoltttions  there  have 


HEALTH  AND  WORLD-PROGRESS       189 

been,  but  always  instigated  and  engineered  by  men  of 
this  small  class  against  one  of  their  own  coterie.  And 
as  long  as  the  peon  remains  the  mere  physical  wreck 
which  he  generally  is,  no  free  constitution  nor  book- 
learning  can  help  him.  The  mere  wish  to  be  free  is  not 
enough;  there  must  be  physical  and  mental  energy  be- 
hind the  wish  to  make  it  a  reality.  As  soon  as  modem 
medicine  brings  the  necessary  relief,  the  peon  will  rise 
and  crush  the  whole  artificial  superstructure  of  class 
rule.    There  are  a  few  indications  of  this  already. 

The  most  progressive  states  of  Mexico  are  those  in  the 
north, — Coahuila,  Chihuahua,  Sonora,  and  Durango ;  they 
have  a  more  temperate  climate  on  account  of  their  great 
altitude,  and  are  more  healthful.  Endemic  diseases  are 
not  nearly  as  prevalent  as  further  south  and  along  the 
sea  coasts,  and  the  people  are  stronger,  more  vigorous, 
and  mentally  alert.  This  difference  in  health  may  explain 
the  various  estimates  placed  on  the  peon  better  than  the 
theory  of  race.  Diametrically  opposite  opinions  are  re- 
ported about  him.  He  is  held  by  some  to  be  a  robber  and 
savage  by  nature,  while  others  regard  him  as  extremely 
intelligent  and  faithful;  some  consider  him  a  ne'er-do- 
well,  others  an  exceedingly  capable  workman,  improving 
rapidly  under  instruction.  The  solution  seems  simple 
enough.  The  peon  who  is  ridden  by  parasites  is  and 
must  be  worthless  as  a  laborer,  and  savage  when  aroused, 
just  as  our  southern  mountaineers  are,  under  similar 
conditions;  while  the  peon  who  comes  from  the  higher 
altitudes  has  a  better  constitution,  and  is  more  willing  and 
capable  to  learn  when  opportunity  offers  under  American 
employment  with  better  pay,  treatment,  and  improved 
housing  conditions.  The  incapables  in  New  York  nearly 
all  belong  to  the  physically  devitalized  class,  while  capa- 
Ue  workers  in  any  occupation  enjoy  at  least  fair  health. 


ll:> 


iV'i 


190      HEALTH  AND  SOCIAL  PROGRESS 

In  New  York  we  classify  the  paupers  and  ne'er-do-wells 
among  the  physically  defective  or  at  least  those  of  low 
vitality;  why  not  do  the  same  with  Mexicans? 

Summing  up,  we  find  that  low  vitality  is  the  cause  of 
nearly  all  the  troubles  in  the  tropics,  because  it  means 
inability  to  perform  and  achieve,  and,  consequently,  the 
absence  of  a  standard  to  measure  the  value  of  promise  to 
perform  on  the  part  of  others.  Hence  superstition  in 
religion  and  credulity  in  politics.  For  the  psychological 
basis  of  both  is  inability  to  perform.  This  is  amply  illus- 
trated in  more  advanced  societies  in  other  realms.  The 
promoter  of  various  "  get-rich-quick  "  schemes  frequently 
and  successfully  appeals  to  ministers  and  teachers,  be- 
cause they  are  not  experts  in  business.  It  is  difficult 
to  "  beat "  a  horsedealer  in  his  line ;  but  he  may  pay 
fifty  dollars  for  a  bushel  of  wheat  "  blessed  "  by  a  re- 
ligious quack — ^an  actual  occurrence  during  1912  in 
Brooklyn,  N.  Y.  Even  intelligent  people  take  to  medical 
nostrums  when  suffering  from  chronic  disease,  or  adopt 
any  medley  of  religio-philosophical  theories.  The  in- 
ability to  perform  in  any  particular  line  provides  an  op- 
portunity for  the  charlatan  of  every  description. 


Fortunately,  the  conditions  just  described  are  not  uni- 
versal in  the  tropics  and  sub-tropics.  There  are  a  num- 
ber of  areas  free  from  at  least  the  worst  of  the  debilitat- 
ing effects  of  endemic  diseases ;  they  are  found  chiefly  in 
the  mountains  and  on  small  islands  in  the  sea  where  the 
breezes  mitigate  the  effects  of  too  great  heat.  We  are 
concerned  here  chiefly  with  the  health  of  islands  in  higher 
altitudes,  since  the  islands  of  the  sea  have  had  compara- 
tively little  influence  on  world-progress. 

The  zones  of  altitude  are  almost  as  important  as  the 


HEALTH  AND  WORLD-PROGRESS       191 

zones  of  latitude.     If  a  mountain  is  sufficiently  high,  it 
may  present  features  of  the  higher  latitudes  in  the  midst 
of    a    tropical    climate,    as    the    temperature    decreases 
normally  one  degree  Fahrenheit  for  every  270  feet  alti- 
tude.    This  means  that  an  altitude  of  5,000  feet  has  a 
temperature  by  18  degrees  lower  than  the  seashore,  and 
in  high  mountains,  such  as  the  Himalayas,  there  results  a 
very  considerable  range  of  flora  and  variety  in  climates. 
The  long  incline  of  Mount  Everest  down  to  the  sea  level 
at  Calcutta,  comprises  in  a  few  miles  the  climatic  con- 
ditions of  Asia  from  arctic  to  tropic;  and  the  southern 
slope  of  Monte  Rosa,  from  the  glacier  cap  to  the  banks 
of  the  river  Po,  yields  within  certain  limits  all  the  vari- 
eties of  climates  in  Europe  from  Lapland  to  the  Medi- 
terranean.    In  a  study  of  health  this  is  very  important, 
since  not  only  heat  decreases  as  we  ascend,  but  absolute 
humidity.     Deaderick  says  that  a  few  hundred  feet  in 
altitude  are  equivalent,  as  far  as  malarial  conditions  are 
concerned,  to  as  many  miles  in  latitude,  although  it  may 
occur  in  places  as  high  as  6,000  feet  within  the  tropics.  To 
a  certain  extent  the  same  holds  true  concerning  uncinari- 
asis, since  in  Colombia  the  portion  of  the  population  living 
below  3,000  feet  altitude  is  infected  to  the  extent  of 
90  per  cent,  while  it  scarcely  occurs  above  that  level.    It  is 
interesting  to  notice  here  that  those  portions  of  South 
America,  e.g.,  Argentina  and  Chile,  which  are  practically 
free  from  these  endemics,  are  the  most  advanced  in  civili- 
zation, and  have  the  most  stable  governments. 

The  important  social  and  climatic  differences  which 
may  often  exist  within  comparatively  short  distances  may 
be  illustrated  by  a  reference  to  Sweden,  where  we  have 
the  Lapps  in  the  north,  and  only  a  hundred  miles  to 
the  south,  the  Swedes;  the  former  merely  eke  out  an 
existence,  the  latter  live  in  comparative  comfort.    The 


192      HEALTH  AND  SOCIAL  PROGRESS 

differences  in  civilization  are  even  greater  between  the 
two  peoples.  Other  countries  show  similar  differences. 
In  the  highlands  of  northern  Palestine  with  their  cool, 
moist,  and  cloudy  climate  we  have  the  Druses  with  their 
blue  eyes  and  brown  hair ;  while  in  the  depression  along 
the  Dead  Sea,  about  120  miles  south,  negroid  types  sur- 
vive. In  the  Blue  Ridge  Mountains  we  have  the  Baltic 
type  who  survive  in  racial  purity,  but  at  their  foot,  100 
miles  or  so  away,  lives  the  negro.  In  central  Italy  and  in 
northern  Spain  the  blonds  are  f  oimd  mostly  in  the  cloudy 
uplands,  while  the  darker  colored  types  live  in  the  valleys. 
These  cases  show  plainly,  that  there  may  exist  great 
differences  of  climate  within  comparatively  small  geo- 
graphical distances,  provided  that  mountains  give  variety 
to  the  landscape. 

Another  factor  may  be  mentioned  here.  Certain  areas 
and  islands  are  entirely  free  from  a  disease,  while  neigh- 
boring localities  are  devastated.  This  immunity  is  ap- 
parently not  due  to  the  absence  of  unfavorable  conditions, 
but  rather  to  the  presence  of  some  inimical  factor  pre- 
venting the  development  of  the  parasite.  And  the  prob- 
lem of  stamping  out  malaria  and  hookworm,  for  instance, 
will  be  greatly  facilitated  if  that  factor  should  be  dis- 
covered. With  the  rapid  development  of  medical  knowl- 
edge in  the  realm  of  bacteria  and  parasites,  it  is  not  un- 
reasonable to  hope  that  such  a  discovery  will  be  made  in 
a  comparatively  short  time,  giving  us  perhaps  a  new  and 
better  explanation  of  these  and  other  diseases  and  their 
influence  upon  man. 

Hills,  mountains,  and  the  plateaus  between  them,  are, 
then,  comparatively  free  from  the  effects  of  most  known 
endemics.  It  was  in  these  localities  that  a  healthier  race 
than  in  the  lowlands  was  developed  all  through  the  ages. 
These  men  are  more  intelligent  and  more  alert  than  those 


HEALTH  AND  WORLD-PROGRESS       193 

in  the  valleys,  just  because  they  are  less  debilitated  by 
disease.  The  conquerors  and  the  men  of  initiative  in 
the  sub-tropics  have  generally  come  from  the  highlands 
all  through  historic  times.  The  Aryans  invading  India, 
the  Medes,  the  Assyrians,  and  even  the  Kurds  of  today 
are  examples.  The  ancient  civilizations  of  the  Incas  in 
Peru  and  that  of  the  Toltecs  and  the  Aztecs  in  Mexico 
had  their  seats  in  cities  located  at  high  altitudes.  The 
Incas  preferred  to  extend  their  conquests  along  the 
Andean  valleys  for  a  stretch  of  1,500  miles;  they  found 
it  easier  to  climb  pass  after  pass  and  mount  to  higher 
altitudes,  than  to  descend  to  the  hot,  steaming  coast  where 
man  and  beast  were  constantly  attacked  by  parasites; 
when  they  finally  did  descend  to  the  seaboard,  their  de- 
generation soon  began  and  a  handful  of  Spaniards  was 
able  to  vanquish  them.  The  areas  which  were  com- 
paratively free  from  endemic  diseases,  have  produced  a 
high  type  of  man  all  over  the  globe,  even  when  they  were 
small;  and  a  civilization  surpassing  that  of  less  healthy 
regions  was  produced.  What  was  the  reason  for  their 
inability  to  pursue  the  course  entered  upon  ?  There  were 
two;  first,  migrations  into  warmer  climates;  second,  the 
limitation  of  the  healthy  areas ;  or  lack  of  continuity,  and 
insufficient  extension. 

1.  Lack  of  Continuity.  The  tendency  of  man  has  al- 
ways been  toward  greater  ease,  and  a  cold,  perhaps  raw 
and  damp,  climate  has  rarely  proved  attractive  to  any 
race.  Hence  we  have  the  numerous  migrations  from  the 
higher  ahitudes  into  the  nearby  valleys,  from  the  plateaus 
of  Central  Asia  both  south  and  west  into  regions  with 
more  favorable  climatic  conditions.  Coming  into  contact 
with  more  comfortably  situated  but  physically  enfeebled 
races,  these  healthier  tribes  had  no  difficulty  in  subduing 
them  and  establishing  new  governments.    A  higher  civili- 


h 
f1 


194  :    HEALTH  AND  SOCIAL  PROGRESS 

zation  resulted,  since  minds  were  stimulated  by  this  con- 
tact, and  the  conquerors — having  enslaved  the  native  races 
— had  leisure  to  develop  whatever  capacities  they  had. 
For  a  while  things  went  well,  and  in  a  number  of  in- 
stances remarkable  progress  was  made.  Then  the  inevi- 
table decline  began,  owing  to  the  fact  that  the  con- 
querors were  unable  to  withstand  the  diseases  of  the 
warmer  climates,  in  which  they  had  never  had  any  racial 
training.  In  the  course  of  time  they  degenerated,  and 
eventually  died  out.  The  civilization  which  had  been 
essentially  the  work  of  a  healthy  race,  could  not  be  con- 
tinued for  long  by  the  enfeebled  native  races,  and  sooner 
or  later  passed  away;  and  the  partially  civilized  natives 
relapsed  to  lower  levels. 

India  and  Egypt  are  good  illustrations  of  this  process. 
The  native  races  of  India  were  never  able  to  attain  a 
high  level  by  their  own  efforts,  since  with  the  conditions 
of  health  indicated  in  previous  chapters,  this  was  abso- 
lutely impossible.  Egypt  was  in  a  similar  position.  With 
endemic  diseases  always  abounding,  no  one  could  live  in 
the  Nile  valley  but  the  fellaheen.  From  time  immemorial, 
conquerors  have  come  from  the  north  and  occasionally 
from  the  mountains  of  the  south  to  become  the  pharaohs 
of  the  country,  always  imposing  their  government  upon 
the  patient  peasantry;  but  the  principal  parts  of  their 
civilization  which  have  come  down  to  us  are  their  huge 
tombs,  in  the  building  of  which  thousands  of  slaves  lost 
their  lives.  Yet  the  slaves  are  there  today,  still  toiling 
for  new  masters  from  the  north;  while  all  the  former 
rulers  died  out  long  ago,  scarcely  leaving  us  their  names. 

And  so  it  was  with  Italy.  How  many  Teutons  were 
there  who  obeyed  the  call  of  their  Emperors  during  the 
Middle  Ages  in  order  to  retain  the  crown  of  "  The  Holy 
Roman  Empire  of  the  German  Nation,"  only  to  find  the 


HEALTH  AND  WORLD-PROGRESS        195 

malaria  of  the  Campagna  and  of  southern  Italy  a  more 
deadly  foe  than  the  stiletto  of  the  crafty  Sicilian!  The 
last  of  the  noblest  dynasty  of  those  conquerors,  Konradin 
the  Hohenstaufen,  met  a  martyr's  death,  due  to  the 
inability  of  his  warriors  to  adjust  themselves  to  the 
parasites.  Thus  has  it  always  been.  The  conqueror 
vanquished  the  enfeebled  population  of  the  warmer 
climates ;  yet  in  the  course  of  time  he  fell  a  victim  to  the 
merciless  but  invisible  foe  which  attacked  his  blood  and 
intestines.  The  native  population,  enervated  and  un- 
progressive  but  sifted  through  the  survival  of  the  fittest, 
still  continues  to  live  and  procreate,  and  is  now  seeing  a 
better  day  ahead  because  modern  science  is  able  to  cope 
with  these  deadly  parasites. 

Civilizations  in  the  past  were,  consequently,  of  neces- 
sity ephemeral.  One  race  of  conquerors  followed  an- 
other in  the  same  country;  and  although  some  of  the 
achievements  of  former  rulers  survived,  the  vast  major- 
ity of  them  were  lost,  and  a  new  start  had  to  be  made 
every  time  that  two  races  came  in  contact  with  each 
other.  Continuity  of  progress  is,  in  other  words,  es- 
sential to  a  high  civilization;  only  where  achievements 
are  handed  down  through  successive  generations,  can 
the  new  generations  start  fairly  well  equipped  for  con- 
quests in  still  unknown  fields  of  knowledge.  Owing, 
then,  to  the  debility  of  races  native  to  warmer  climates, 
and  to  the  inability  of  races  from  healthier  localities  to 
adapt  themselves  to  such  climates,  no  continuity  of  prog- 
ress was  possible,  nor  could  any  civilization  of  antiquity 
rise  beyond  a  certain  level. 

2.  Insufficient  Extension.  The  other  reason  for  the 
failure  of  the  peoples  in  the  healthy  areas  to  rise  higher 
was  the  limitation  of  these  areas.  No  high  civilization  is 
ever  built  up  by  a  single  people,  no  matter  how  capable 


• 


196      HEALTH  AND  SOCIAL  PROGRESS 

it  may  be.  One  must  leam  not  only  from  predeces- 
sors, but  from  contemporaries.  Exchanges  of  views  must 
not  only  be  ntmierous,  but  varied.  In  proportion  as  a 
capable  people  enters  into  friendly  relations  with  other 
fairly  well  advanced  nations,  will  it  develop  by  receiving 
and  giving  suggestions.  The  healthy  areas  in  the  tropics 
and  sub-tropics  are  generally  of  small  extent,  and  hence 
are  able  to  support  only  small  populations,  more  particu- 
larly in  former  ages  when  the  means  for  increasing  the 
food  supply  were  limited  to  the  domestication  of  animals 
and  to  a  crude  form  of  agriculture.  Social  and  religious 
conditions  forbade,  moreover,  too  frequent  or  too  varied 
contact  with  foreign  races.  Diffidence,  which  poor  health 
always  implies,  generally  prevented  people  from  extend- 
ing their  social  consciousness  beyond  the  tribal  domain, 
since  they  lacked  the  courage  bom  of  good  health  to 
conquer  unknown  difficulties  or  even  to  wrestle  with 
those  immediately  at  hand.  The  expansiveness  and  good 
nature  of  vigorous  health  was  a  rare  occurrence  in  those 
times,  and  this  is  reflected  in  the  social  and  religious 
creeds  of  primitive  man — and  of  savage  man  in  all 
climates  today — who  look  upon  every  foreigner  as  an 
enemy  and  every  worshiper  of  a  different  deity  as  a 
heretic.  The  history  of  religious  persecutions  even  in 
comparatively  modern  times  is  a  confirmation  of  this 
statement,  since  the  foremost  persecutors  of  other  creeds 
were  generally  men  in  poor  health — if  one  may  judge 
from  their  gaunt  figures  and  emaciated  features.  The 
recent  "  holy  war "  of  the  Greeks,  Servians,  and  Bul- 
garians against  the  Turks  was  justly  ridiculed  by  many 
people,  ignorant  of  the  sanitary  conditions  in  the  Bal- 
kans, since  it  was  a  most  unholy  one,  although  the 
savagery  of  all  parties  was  inexplicable  to  the  critics. 
The  fact  pf  the  Allies  attacking  each  other  after  the 


HEALTH  AND  WORLD-PROGRESS       197 

defeat  of  the  Turks,  justifies  the  inference  that  the  cruel- 
ties perpetrated  by  all  parties  to  this  war  and  the  narrow- 
ness of  their  social  and  religious  consciousness  may  be 
due  largely  to  the  general  ill  health  of  these  peoples, 
induced  by  endemic  diseases.  We  have  here  another  case 
like  that  of  the  Mexicans  discussed  above — ^peoples  rav- 
aged for  generations  by  endemic  diseases,  consequently 
without  balance;  and,  when  aroused,  satisfying  merely 
animal  instincts  of  lust  and  revenge  without  let  or  hin- 
drance. All  parties  were  drunk  with  blood,  and  lost  all 
control  of  themselves.  Concerning  Greece  we  know  that 
malaria  is  very  prevalent,  and  concerning  the  other  coun- 
tries we  simply  lack  statistical  evidence,  although  the 
disease  is  widespread  and  others  may  exist.  (See  the 
Preface  for  an  explanation  of  the  inactivity  of  750,000 
men  owing  to  malaria.) 

In  localities  where  endemic  diseases  were  at  least  rare, 
and  a  healthier  stock  could  develop  in  the  course  of  time, 
social  consciousness  still  continued  to  be  comparatively 
narrow  owing  to  inherited  customs  which  it  is  always 
difficult  to  change,  especially  among  people  on  lower 
planes  of  civilization.  Hence  these  people  would  not 
enter  into  any  but  hostile  contact  with  others,  and  the 
enslavement  or  extirpation  of  the  defeated  peoples  was 
almost  inevitable.  This  prevented  a  profitable  exchange 
of  views  and  kept  the  civilization  even  of  healthy  races  on 
comparatively  low  levels,  since  no  single  race  has  been 
able  to  rise  very  high  unaided  by  the  efforts  of  others. 
The  rapid  spread  and  high  development  of  modern  civili- 
zation is  among  other  things  due  to  the  rapid  extension 
of  our  means  of  communication,  which  has  enabled  every 
civilized  nation  to  be  teacher  as  well  as  pupil  of  every 
other.  And  the  most  advanced  nations  in  the  spread  of 
civilization  are,  and  always  have  been,  the  healthiest, 


198       HEALTH  AND  SOCIAL  PROGRESS 

because  they  have  had  the  courage  to  face  all  kinds  of 
dangers,  and  confidence  in  their  ability  to  cope  with  all 
sorts  of  difficvdties.  The  pioneers  in  discoveries  have 
always  enjoyed  good,  if  not  abounding,  health. 

Two  conditions  are,  then,  necessary  for  a  high  civili- 
zation—continuity of  progress  and  sufficient  extension. 
These  two  factors  have  met  only  in  the  history  of  the 
White  Race,  and  more  particularly  in  that  of  the  Baltic 
stock.  Since  it  is  admitted  that  intelligence  is  not  con- 
fined to  one  kind  of  pigmentation  or  to  one  head  form,  as 
we  saw  above ;  and  since  the  origin  of  the  physical  dif- 
ferentiations is  still  an  unsolved  and  exceedingly  com- 
plex problem — witness,  for  instance  in  the  case  of  the 
negro,  the  existence  of  a  dense  cuticle,  diminished  perspi- 
ration, smaller  chest  with  less  perspiratory  power,  lower 
temperature  with  a  more  rapid  pulse,  and  constant  sub- 
jection to  endemic  diseases,  all  of  which  variations  may 
enter  into  the  question  of  coloring — we  need  not  enter 
into  even  a  brief  discussion  of  racial  beginnings.*  We 
are  concerned  only  with  the  question  of  higher  men- 
tality as  the  cause  of  civilization. 

Our  direct  human  ancestors  originated  in  all  proba- 
bility in  the  Indian  archipelago,  since  the  oldest  human 
remains  have  been  found  there  on  the  island  of  Java. 
From  the  archipelago  migrations  took  place  in  a  north- 
western direction  into  Asia,  and  here  the  stream  divided, 
turning  along  the  coasts,  east  and  west,  and  northward 
into  the  higher  altitudes;  one  stream  eventually  getting 
into  Europe  and  another  into  Africa.  The  details  of  these 
migrations  and  the  problem  of  the  population  of  America 
and  of  the  Pacific  islands,  do  not  concern  us.    Our  only 

*  The  most  acceptable  theory  is  that  of  Professor  Giddings,  as 
given  by  F.  Stuart  Chapin  in  Social  Evolution,  pp.  208-226, 
on  the  basis  of  unpublished  lectures. 


HEALTH  AND  WORLD-PROGRESS    i  199 

problem  is  that  of  the  increase  of  mentality  as  affected  by 
these  migrations.  The  Indian  archipelago  is  notoriously 
insalubrious,  and  man  could  make  comparatively  little 
progress  there,  as  is  proved  by  the  low  mental  condition 
of  the  aborigines  of  Borneo  and  Australia.  The  further 
north  he  went,  the  more  healthful  were  the  regions  he 
entered ;  the  stream  of  migration  which  eventually  turned 
into  Africa  lost  some  of  the  mentality  gained  during  the 
long  sojourn  in  more  salubrious  regions  and  dropped  to 
lower  levels  owing  to  the  notoriously  bad  sanitary  con- 
ditions of  that  continent. 

One  question  must  be  answered  before  we  proceed. 
What  was  the  motive  for  these  migrations?  The  usual 
answer  has  been  overpopulation.  Even  today  the  great 
continent-like  areas  of  Borneo,  New  Guinea,  Sumatra, 
and  some  of  the  larger  islands  of  the  Philippine  group 
have  a  sparse  population,  and  Australia  is  noted  for  its 
exceedingly  few  inhabitants  all  over  the  northern  central 
districts.  It  is  true  that  some  of  the  smaller  islands  in 
the  archipelago  are  densely  populated,  but  this  is  due  to 
local  conditions  which  have  been  produced  by  Europeans, 
who  selected  the  most  fertile  regions  favorable  for  the 
cultivation  of  special  products.  A  striking  example  is 
furnished  by  Amboina,  the  isle  of  the  famous  clove  mo^ 
nopoly  where  the  population  reaches  1 ,000  per  square  mile, 
while  in  the  other  Moluccas,  where  Papuan  influences  are 
strong,  it  drops  to  20.  Underpopulation  is  found  over 
the  larger  part  of  the  tropics.  "  Economic  and  social  re- 
tardation have  kept  the  hot  belt  relatively  underpopulated. 
The  density  map  shows  much  the  largest  part  of  it  with 
a  population  less  than  25  to  the  square  mile.  Only  the 
small  portion  contained  in  India,  southernmost  China, 
and  Java  shows  a  density  over  125  to  the  square  mile. 
This  density  has  to  rise  to  500  or  more  to  the  square  mile 


200      HEALTH  AND  SOCIAL  PROGRESS 

before  emigration  begins.  The  would-be  exiles  then  have 
a  wide  choice  of  new  homes  in  other  tropical  lands,  where 
they  find  congenial  climate  and  phases  of  economic  de- 
velopment into  which  they  will  fit." "»  Compare  this 
statement  with  the  following  by  the  same  author. 

"In  the  tropical  highlands  of   Mexico,  Central  and 
South  America, — concentration  of  population  and  its  con- 
comitant cultural  development  begin  to  appear  above  the 
2,000  meter  line.    Here  are  the  chief  seats  of  population. 
Mexico  has  three  recognized  altitude  zones,  the  cold,  the 
temperate,  and  the  hot,  corresponding  to  plateau,  high 
slopes  and  coastal  piedmont  up  to  1,000  meters;— but  the 
first  two  contain  nine-tenths  of  the  people.     While  the 
plateau  has  in  some  sections  a  population  dense  as  that 
of  France,  the  lowlands  are  sparsely  peopled  by  wild 
Indians  and  lumbermen.     Ecuador  has  three-fourths  of 
its  population  crowded  into  the  plateau  basins   (mean 
elevation  2,500  meters)  inclosed  by  the  ranges  of  the 
Andes.     Peru   presents   a  similar  distribution,   with   a 
comparatively  dense  population,  on  a  plateau  reaching  to 
3,500  meters  or  more,  though  its  coastal  belt  being  health- 
ful, dry,  and  fairly  well  supplied  with  irrigation  streams 
from  the  Andes,  is  better  developed  than  any  other  simi- 
lar district  in  tropical  America.    In  Bolivia,  72  per  cent 
of  the  total  population  live  at  an  altitude  of  6,000  to 
14,000   feet,  while  five  out  of   the  nine  most  densely 
populated  provinces  lie  at  elevations  over  11,000  feet."  "* 
Overpopulation  of  the  tropics  cannot,  then,  have  been 
the  motive  for  emigration  northward  from  the  Indian 
archipelago,  since  the  stress  of  population  must  have 
been  less  in  pre-historic  times  than  it  is  today.    Primitive 
man  had,  moreover,  means,  as  savage  man  has  today, 
for  preventing  this  calamity  by  killing  off  the  old  people 
and  the  children. 


HEALTH  AND  WORLD-PROGRESS       201 

Neither  can  the  motive  for  migration  be  found  in  the 
scarcity  of  food,  since  the  regions  mentioned  and  the  hot 
belt  in  general  are  more  productive  with  less  labor  than 
higher  altitudes  or  latitudes.  Any  possible  scarcity  of 
food  was  easily  remedied  by  cannibalism  within  the  group 
or  without  by  war,  since  the  bodies  of  slain  friends  as 
well  as  of  foes  could  be  and  were  used  not  only  in  emer- 
gencies but  often  as  a  delicacy.  Owing  to  his  general 
aversion  to  needless  exertion  man  has  never  entered  upon 
long  journeys  or  other  hardships  without  an  urgent 
reason.  In  primitive  times  he  was  even  less  inclined  to 
do  so  on  account  of  his  diffidence  and  his  ignorance  of 
overcoming  obstacles.  Yet  we  see  him  go  north  and 
climb  mountain  slopes  to  establish  a  habitat.  What  was 
the  strong  motive  which  induced  him  to  abandon  the 
favorable  conditions  in  the  valleys  of  warm  climates? 

The  dread  of  disease  is  the  only  answer  to  this  ques- 
tion. Even  in  earliest  times  man  must  have  noticed  the 
tremendous  mortality  which  he  found  all  around  him,  and 
must  have  feared  a  like  fate,  since  the  love  of  life  has 
been  the  one  permanent  instinct  of  the  human  race.  The 
"  will  to  live "  is,  perhaps,  stronger  in  nature-peoples 
than  in  the  civilized,  notwithstanding  the  small  value  put 
upon  life  by  the  lower  races.  It  is  one  thing  to  value  other 
persons'  lives  lightly ;  it  is  quite  different  when  it  comes 
to  one's  own.  The  savage  is  unsophisticated  in  this  mat- 
ter, and  while  he  has  but  little  to  live  for,  the  dread  of 
death,  once  he  has  acquired  sufficient  intelligence  to  form 
an  idea  of  it,  is  a  strong  motive  for  almost  superhuman 
exertion.  We  see  this  almost  daily  in  the  lower  strata  of 
civilized  nations  where  people  without  the  comfort  of 
religion  and  philosophical  resignation,  stand  in  perfect 
terror  of  death,  and  would  rather  suffer  any  privations 
fhan  submit  to  the  inevitable.    How  much  more  horrify- 


202       HEALTH  AND  SOCIAL  PROGRESS 

ing  must  this  calamity  have  appeared  to  man  after  he  had 
peopled  the  world  with  all  sorts  of  evil  spirits,  and  had 
no  way  of  reconciling  himself  to  his  fate  by  the  comforts 
of  a  more  rational  view  of  the  world  ?  Life  was  hard,  but 
death  was  terrible!  And  so  he  struggled  with  all  his 
power  to  postpone  the  evil  day.  The  best  way  to  do  that 
was  to  seek  more  healthful  regions. 

We  need  not  assume  that  the  discovery  of  the  possi- 
bility for  a  longer  life  was  made  suddenly.  It  came  like 
all  other  discoveries  and  inventions  gradually  and  acci- 
dentally. The  man  who  had  wandered  into  the  hills  in 
search  of  food  or  in  stalking  game  must  have  felt  the 
exhilaration  of  a  purer  atmosphere  and  the  beneficent 
effect  of  the  absence  of  at  least  some  insect  pests.  Man 
was  teachable,  and  he  deliberately  repeated  the  experi- 
ence. In  the  course  of  time  he  formed  a  dim  and  crude 
notion  about  this  matter,  and  the  most  enterprising  men 
must  sooner  or  later  have  gone  in  search  for  such  locali- 
ties. These  men  were  naturally  the  strongest,  since  they 
alone  could  undergo  the  hardships  of  even  moderately 
distant  travel.  In  these  localities  they  gained  better 
health  and  greater  strength,  and  perhaps  began  to  prey 
upon  the  people  in  the  valleys.  Owing  to  the  plasticity 
of  early  man,  new  stocks  with  greater  vitality  and  men- 
tality were  soon  formed,  and  both  became  incentives  to 
further  exercise  of  physical  and  mental  faculties,  since 
good  health  with  surplus  energy  craves  for  an  outlet. 
The  weaker  members  were  left  in  the  less  wholesome 
regions,  as  is  the  case  today,  and  as  brought  out  so  strik- 
ingly by  Miss  Semple  in  the  passage  quoted  above  con- 
cerning Peru,  Bolivia,  and  Ecuador.  Little  or  no  prog- 
ress was  possible  under  these  conditions,  and  the  typical 
"  deadly  climates  "  have  always  been  the  abode  of  devi- 
talized and  uncivilized  peoples.     The  migrants,  on  the 


HEALTH  AND  WORLD-PROGRESS       203 

other  hand,  traveled  on,  always  leaving  the  weaklings  be- 
hind in  what  seemed  to  the  latter  favorable  places  for 
settlement ;  they  separated  and  traveled  in  different  direc- 
tions, driven  partly  by  genuine  Wanderlust,  and  partly 
by  the  desire  to  match  their  wits  and  courage  against  new 
difficulties.  In  the  course  of  time  these  groups  became 
estranged,  changed,  and  when  their  descendants  met  after 
thousands  of  years  in  entirely  new  countries  they  fought 
each  other  for  the  best  localities  in  which  to  make  a 
living;  but  the  battle  always  went  to  the  strongest,  i.e., 
the  healthiest.  The  peoples  of  the  mountains  or  from 
comparatively  disease-free  plains  always  subjugated  those 
in  the  less  salubrious  but  more  fertile  plains,  and  the 
contact  between  two  different  stocks  generally  had  a 
deepening  and  broadening  effect  upon  the  minds  so  that 
new  civilizations  sprang  up  here  and  there  in  the  tropics 
and  sub-tropics.  All  of  them  were,  however,  local  and 
ephemeral,  since  the  healthful  areas  were  nowhere  of 
sufficient  extent  to  enable  a  large  number  of  people  to 
exchange  ideas,  and  since  the  small  number  of  conquerors 
subjugating  a  large  population  in  less  sanitary  but  more 
fertile  regions  invariably  succumbed  sooner  or  later  to 
the  endemic  diseases,  leaving  the  natives  with  a  culture 
which  they  were  unable  to  maintain  long,  because  of  their 
inherent  physical  and  mental  weakness.  We  must  come 
back,  therefore,  to  our  problem  of  the  civilization  pro- 
duced by  the  white  race  and  more  particularly  by  the 
Baltic  or  Teutonic  stock,  since  this  alone  has  had  con- 
tinuity of  progress  and  sufficient  extension  to  mature 
into  a  truly  high  and  world-wide  culture. 

In  the  Mediterranean  countries  we  have  for  the  first 
time  a  combination  of  circumstances  which  made  a  con- 
tinuity  of  progress  possible  and  permitted  a  sufficient 
extension  of  civilization  to  insure  the  contact  of  numerous 


•I., 


304      HEALTH  AND  SOCIAL  PROGRESS 

and  varied  races  and  stocks.    An  independent  civilization 
sprang  up  in  Mesopotamia  and  another  in  Egypt;  both 
were  located  in  fertile  river  valleys,  and  both  were  the 
result  of  strong  and  healthy  races  coming  in  contact  with 
peoples    who    had,    under    the    influence   of    favorable 
climates,  built  up  a  fair  material  culture.     The  native 
races  were  unable  to  rise  above  the  level  of  economic 
considerations,  and  only  the  more  virile  races  who  came 
from  northern  countries  could  add  a  touch  of  something 
more  spiritual  to  this  culture  by  art,  religion,  and  phi- 
losophy.   When  the  invaders  succumbed  to  the  endemic 
diseases,  a  relapse  into  a  lower  condition  invariably  re- 
sulted, and  only  a  new  set  of  conquerors  from  a  dif- 
ferent country  could  take  up  the  thread  and  spin  it  fur- 
ther.   For  Egypt  has  been  ruled  by  foreigners  from  time 
immemorial  to  the  present  day.    Fortimately,  the  inter- 
regnum was  never  too  long,  and  the  new  dynasty  could 
always  begin  at  least  somewhere  near  the  plane  where  its 
predecessors  left  oflF.    Some  of  these  dynasties  conquered 
other  countries,  both  south  and  northeast,  and  thus  the 
Mesopotamian  and  Egyptian  civilizations  came  in  contact 
with  each  other.    A  conquest  of  Nineveh  by  Amenophis 
II  is  reported  as  early  as  1566  B.C.;  and  from  that  time 
on  the  intercourse  between  the  two  countries  was  almost 
continuous,  owing  to  the  fact  that  both  countries  strove 
for  the  mastery  of   Syria  and  Palestine,  until  Essar- 
haddon  of  Assyria  captured  Egypt  about  671  B.C.    An 
important  civilization  had  also  developed  in  the  island 
of  Crete ;  and  the  rivalries  between  Egypt  and  Mesopo- 
tamia gave  the  Phoenicians  an  opportunity  to  create  a 
dominant  power  along  the  Mediterranean,  not  so  much 
by  conquest  as  by  commerce.     Greece  and  Italy  must 
have  been  affected  by  these  movements,  and  if  the  theory 
of  Baltic  immigration  should  be  based  on  fact,  these 


HEALTH  AND  WORLD-PROGRESS       205 

blonds  would  have  found  a  civilization  well  advanced  and 
of  a  sufficiently  high  and  varied  character  to  fertilize  the 
minds  of  a  vigorous  race.  Thus  Greek  and  Roman  cul- 
ture developed  on  the  basis  of  all  those  produced  by  the 
peoples  along  the  Mediterranean.  As  these  two  peoples 
of  apparently  Baltic  stock  perished  through  their  lack 
of  racial  training  against  malaria  and,  most  probably, 
uncinariasis,  their  civilization  dropped  to  lower  levels, 
since  the  disease-ridden  but  acclimated  natives  of  these 
countries  could  not  raise  civilization  beyond  a  certain 
plane  without  the  assistance  of  a  more  vigorous  race  that 
had  accumulated  a  vast  store  of  vitality  in  healthful 
countries. 

From  the  fall  of  the  Roman  Empire  at  the  hands  of 
later  Teuton  invaders — all  of  whom  shortly  perished  of 
these  prevalent  diseases— to  the  present  time,  civilization 
has  gradually  moved  northward,  first  to  Florence,  Milan, 
and  Venice,  then  to  France,  Germany,  England,  Den- 
mark, and  Scandinavia.     While  Italy  is  still  prominent 
in  art,  Denmark  has  developed  remarkably  in  that  respect, 
and   Scandinavians  are  becoming  more   prominent   as 
writers  of  really  important  literature.     The  Latin  na- 
tions, notably  France  and  Italy,  may  be  able  to  hold 
their  place  as  teachers  of  the  fine  arts  owing  to  the  vast 
accumulations  of  classical  remains  in  their  museums,  but 
the  science  and  art  of  producing  and  distributing  wealth 
and  creating  welfare  among  the  masses,  are  now  taught 
by  Teuton  countries.    The  Scandinavians,  the  Germans, 
the  English  with  their  colonies,  and  the  Americans,  are 
now  leading  the  world  in  all  matters  pertaining  to  social 
well-being,  and  are  likely  to  keep  the  lead  for  a  long 
time  over  the  Latins,  since  they  are  not  handicapped  by 
fighting  a  constant  foe  to  their  vitality.    Italy  and  Greece 
may  be  able  to  avert  the  worst  forms  of  devitalization  by 


206      HEALTH  AND  SOCIAL  PROGRESS 

the  application  of  modern  scientific  methods,  but  that 
costs  money  which  the  other  countries  are  able  to  apply 
to  productive  uses.  "  Ricchi  calculates  that  the  Adriatic 
Railway  Company  alone,  for  1.400  kilometers  of  rail- 
way and  for  6,416  workmen  in  the  malarial  zones,  spends 
on  account  of  malaria  the  enormous  sum  of  1,050,000 
francs  a  year."  "*  This  disease  and  its  eventual  eradica- 
tion will  cost  Italy  and  Greece  enormous  sums,  and  even 
then  the  battle  will  only  half  be  won,  since  it  will  take 
many  years  before  the  depleted  constitutions  can  be 
brought  up  to  the  normal  so  as  to  produce  balanced  brains 
and  bodies. 


We  have  come  to  the  end  of  our  review  of  civilization 
as  affected  by  health.  European  culture  has  become  pos- 
sible on  account  of  its  continuity  of  progress  and  ex- 
tension. Around  the  Mediterranean  alone  were  there 
extensive  areas  where  civilization  could  rise  to  com- 
paratively high  levels  owing  to  better  sanitary  conditions 
than  are  found  in  the  tropics  and  sub-tropics.  There 
alone  are  different  races  found  which  assured  not  only 
numerous  but  varied  contacts  so  as  to  stimulate  the  mind. 
There  alone  we  find  an  almost  continuous  influx  of 
healthier  and  stronger  northern  races  which  respond 
readily  to  the  stimuli  of  more  favorable  conditions  than 
they  had  in  their  native  habitats.  A  continuity  of  prog- 
ress was  thus  made  possible,  and  a  gradual  movement  of 
civilization  further  north  toward  the  regions  which  are 
practically  free  from  endemic  diseases.  The  races  living 
there  enjoy  good  health  and  have  strong  vitality.  The 
average  duration  of  life  in  Sweden  is  50.9  years  for 
males  and  53.6  for  females;  in  Denmark  50.2  and  53.2; 
in  France,  the  country  with  the  next  highest  records,  45.7 


HEALTH  AND  WORLD-PROGRESS       207 

and  49.1 ;  in  England  and  Wales,  44.1  and  47.7 ;  in  Massa- 
chusetts 44.1  and  46.6;  in  Italy,  42.8  and  43.1 ;  in  Prussia 
41.0  and  44.5;  in  India,  23.0  and  24.0,  respectively."* 
These  figures  are  a  proof  of  the  strong  vitality  of  the 
Scandinavians,  with  an  average  longer  life  of  8  years 
for  males  and  more  than  10  years  for  females  as  com- 
pared with  Italy.  This  fact  will  assure  the  continuity 
and  permanence  of  civilization,  since  the  neighboring 
countries  are  likewise  healthful  and  are  productive  of 
high  vitality.  These  races  are,  moreover,  spreading  over 
the  whole  globe,  and  willingly  adopt  anything  advanta- 
geous to  themselves  and  transmit  it  to  others.  World 
commerce — ^now  almost  entirely  in  the  hands  of  the  Baltic 
race — ^brings  about  the  most  numerous  and  varied  con- 
tacts between  all  races,  and  stagnation  is  thus  precluded 
for  a  long  time  to  come.  All  the  conditions  for  a  perma- 
nent and  world-wide  civilization  are  meeting  now  for  the 
first  time  in  the  history  of  mankind,  and  science  is  just 
beginning  to  study  and  improve  them  with  the  purpose 
of  conveying  these  benefits  to  all  peoples. 


CHAPTER  XII 


HEALTH  AND  WORLD-PROGRESS  (Concluded) 

Is  civilization  always  to  be  precarious,  as  it  has  been 
in  the  past?  Or  is  it  always  to  be  looked  upon  as  the 
result  of  degeneration,  as  it  is  by  some  at  the  present 
time,  on  the  basis  of  the  philosophy  popularized  by  J.  J. 
Rousseau  and  Cesare  Lombroso?  If  so,  the  present  in- 
tensity of  the  struggle  for  a  higher  life  and  for  a  more 
general  spread  of  civilization  ought  to  be  discounte- 
nanced ;  since,  if  bringing  knowledge  to  the  poor  only  in- 
creases their  misery,  and  if  giving  culture  to  nature- 
peoples  only  dooms  them  to  extinction,  our  endeavor  in 
scattering  the  fruits  of  European  achievements  over  the 
globe  would  be  nothing  short  of  criminal.  It  would 
justify  the  claims  of  those  who  say  that  civilization  is  a 
curse  and  the  only  life  worth  living  is  that  of  nature  in 
its  unadorned  state. 

It  cannot  be  denied  that  many  nature-peoples  have 
become  extinct,  because  rapacity  on  the  part  of  the  com- 
mercial and  political  exploiters  took  the  best  they  had 
and  gave  them  the  worst  in  return ;  and  our  ignorance  of 
tropical  endemic  diseases  prevented  the  possibility  of  our 
rendering  aid  to  them  in  the  only  manner  where  assistance 
was  of  real  importance.  A  change  is,  however,  beginning 
to  come  into  our  policies  toward  the  peoples  of  the 
tropics.  It  is  becoming  recognized  that  the  world  needs 
them,  and  that  it  is  necessary  to  have  them  in  good  health, 
so  that  beside  the  happiness  which  will  come  to  the  people 
themselves,  they  will  be  able  to  produce  the  various  kinds 

208 


HEALTH  AND  WORLD-PROGRESS      209 

of  food  which  only  a  warm  climate  can  produce.  In  the 
past  men  from  the  north  had  to  go  south  and  settle  there 
if  they  wanted  to  enjoy  those  products.  The  result  was 
always  the  same— decay  and  extinction.  A  later  policy 
of  exploitation  became  possible  with  better  means  of 
transportation.  This  has  likewise  been  recognized  as 
being  unwise,  for  if  the  people  inhabiting  the  tropics 
should  become  extinct,  who  would  raise  those  products 
which  we  need  to  an  ever-increasing  extent?  For  even 
with  our  knowledge  of  how  to  cure  tropical  diseases, 
men  from  the  north  will  not  be  ready  for  some  centuries 
to  settle  permanently  in  warm  countries,  since  it  is  one 
tiling  to  endure  a  climate  and  quite  another  to  thrive  in 
it  It  is,  therefore,  necessary  for  civilized  peoples  to 
form  a  sound  and  coherent  policy  in  regard  to  the  tropics, 
if  their  culture  is  to  extend  and  encircle  the  globe  so  as 
to  benefit  all. 

The  precariousness  of  civilization  in  the  past  as  dis- 
cussed in  previous  chapters,  was  due  mainly  to  two 
reasons — the  small  areas  of  the  isles  of  health,  and  the 
extinction  of  the  migrants  from  the  north  in  lower  lati- 
tudes. Thus  neither  a  large  extent  nor  continuity  of 
culture  was  possible,  and  it  could  never  rise  to  a  high 
level.  A  third  reason  may  now  be  added — the  impossi- 
bility of  maintaining  large  cities  in  a  sanitary  condition 
for  a  long  time. 

3.  Unsanitary  Condition  of  Cities.  In  the  past  the 
city  has  always  been  a  devourer  of  people  from  the 
country.  Hardly  any  of  the  city  families  prospered  be- 
yond the  third  generation.  "  If  the  conditions  in  city  life 
generally  or  in  a  given  city  are  conducive  to  human 
mortality,  it  .nay  well  be  that  city  life  generally  or  the 
life  of  some  city  in  particular,  may  be  of  such  a  bad  char- 
acter that  the  death  rate  is  higher  than  the  birth  rate.    If 


210       HEALTH  AND  SOCIAL  PROGRESS 

that  is  the  case  the  city  is  dependent  upon  migration  to 
It,  not  only  for  its  increase  in  population  but  as  well  for 
its  continued  existence  as  a  city. 

"  We  may  say  that  this  was  the  condition  of  most 
cities  in  the  European  world  prior  to  the  opening  of  the 
nineteenth  century.  Thus  it  is  said  that  in  London  in  the 
forty  years  from  1603-44  there  were  363,935  burials 
and  330,747  christenings.  A  German  student  who  inves- 
tigated the  church  records  of  baptisms  and  burials  in 
several  German  cities  came  to  the  conclusion  that  on  the 
average  there  were  eighty  or  ninety  births  to  one  hundred 
deaths  m  the  period  from  1550-1750."  "* 

Through  better  sanitation  and  greater  medical  skill 
cities  have  constantly  reduced  their  death  rate  during  the 
nineteenth  century,  so  that  they  themselves  are  furnishing 
from  one-fourth  to  one-half   of  the  increase  in   their 
population  in  Sweden  and  Germany  and  about  three- 
quarters  of  their  increase  in  Great  Britain.    In  1900  the 
mortality  of  the  United  States  per  1,000  was   15.4  in 
rural  districts  and  18.6  in  urban.     Since  that  time  the 
death  rate  has  been  reduced  still  further,  so  that  New 
York  City,  for  instance,  has  had  an  excellent  record  with 
16  deaths  per  1,000  in  1909;  15.98  in  1910;  15.13  in  1911  • 
14.11  in  1912,  and  13.77  in  1913.    Other  large  cities  have 
similar  small  death  rates;  e.g.,  Chicago  in  1912,  14  68* 
Paris,  16.38;  Berlin,  14.39;  London,  13.52.     With  in- 
creased knowledge  of  hygiene  and  dietetics,  better  sanita- 
tion and  greater  medical  skill,  the  cities  may  eventually 
be  able  to  balance  their  death  and  birth  rates.     In  any 
event,  no  civilized  city  will  ever  share  the  fate  of  many 
ancient  cities  of  becoming  a  ruin  after  a  few  hundreds 
of  years,  because  of  plagues  and  other  diseases  arising 
from  filth  and  dirt.     No  such  spectacle  will  be  offered 
to  future  generations  concerning  Paris  and  London  as 


HEALTH  AND  WORLD-PROGRESS       211 

we  have  of  Troy  and  Babylon,  where  we  find  several 
cities  buried  one  under  the  other.  These  modem  cities 
may  fall  some  time,  but  not  on  account  of  devastating 
diseases,  and  Macaulay's  famed  traveler  from  New  Zea- 
land may  have  to  wait  some  thousands  of  years  before 
he  can  view  the  ruins  of  the  imperial  city  from  London 

bridge. 

The  significance  of  the  city  for  civilization  lies  chiefly 
in  the  fact  that  there  contacts  between  human  beings 
are  both  numerous  and  varied — one  of  the  essentials  of 
high  mental  development.    In  the  past  as  well  as  today, 
the  cities  have  generally  produced  or  at  least  harbored 
the  most  intelligent  men.     Men  of  ability  and  ambition 
have  always  sought  in  the  urban  centers  the  larger  op- 
portunities for  meeting  people  with  gifts  different  from 
their  own.    Because  of  the  unsanitary  conditions  in  the 
cities  of  the  past,  these  men  often  fell  victims  to  various 
diseases  and  were  hardly  ever  able  to  give  their  children 
strong  constitutions,  so  that  mankind  could  not  benefit 
from  generations  of  well-born  sons  and  daughters  de- 
scended from  famous  men.     Hence  most  of  the  good 
stock  ended  with  its  most  prominent  member,  or  the 
offspring  was  decidedly  inferior.     The  city  thus  epito- 
mizes the  two  conditions  discussed  above.    Owing  to  poor 
conditions  of  health,  cities  in  the  past  could  never  be 
large ;  contacts  were,  consequently,  always  comparatively 
few  and  similar.    For  the  same  reason  cities  could  never 
have  a  long  life,  and  continuity  was  impossible.    As  the 
southern  plains  and  valleys  attracted  the  more  healthy 
men  from  the  hills  or  from  the  north  only  to  produce  an 
efflorescence  of  civilization  before  their  inevitable  decay 
commenced,  so  the  cities  enticed  the  most  capable  men 
into  their  walls  where  greater  opporttmities  offered  every 
facility  for  a  higher  mental  development  but  undermined 


212       HEALTH  AND  SOCIAL  PROGRESS 

their  vitality.    Under  these  conditions  an  extensive  and 
continued  civilization  was  impossible. 

At  present,  cities  are  not  only  improving  their  sanitary 
conditions  and  thus  insuring  their  continuity,  but  they 
are  becoming  constantly  larger  and  furnish  better  oppor- 
tunities for  more  numerous  and  varied  contacts.    Accord- 
ing to  the  census  of  1910  our  urban  communities  con- 
tained 46.3  per  cent  of  the  total  population,  and  incor- 
porated places  of  less  than  2,500  inhabitants  8.8  per  cent, 
making  55.1  per  cent  residing  under  conditions  more  or 
less  urban  in  character.    And  the  cities  are  attracting  not 
only  the  stronger  elements  from  the  country  districts, 
but  the  better  class  of  the  foreigners.    The  urban  com- 
munities had  72.2  per  cent  of  the  foreign  bom,  65.3  per 
cent  of  those  of  foreign  or  mixed  parentage,  and  only 
27.4  per  cent  of  the  negroes;  while  the  rural  communi- 
ties had  27.8  per  cent,  34.7  per  cent,  and  72.6  per  cent 
of  these  elements,  respectively.    Whatever  one  may  think 
about  foreigners  locating  in  cities,  they  furnish  at  least 
many  incentives  for  thought,  and  often  reveal  remarkable 
ability  under  the  stimulating  influences  of  urban  life. 
Civilization   is   thus   likely   to   rise   higher   and   spread 
farther,  since  the  cities  are  more  directly  in  contact  with 
every  corner  of  the  globe  through  improved  methods  of 
communication,  and  attract  the  most  ambitious  and  capa- 
ble men  from  everywhere. 

It  is  perhaps  due  to  this  fact  that  not  only  has  civiliza- 
tion taken  tremendous  strides  during  the  nineteenth  cen- 
tury, but  that  cities  have  developed  phenomenally  during 
that  period.  No  reference  need  be  made  here  to  Ameri- 
can cities,  since  their  rapid  growth  is  well  known ;  but  a 
few  statistics  concerning  some  of  the  older  cities  may 
serve  to  illustrate  this  point.  "  London  is  probably  two 
thousand  years  old,  and  yet  four-fifths  of  its  growth 


HEALTH  AND  WORLD-PROGRESS       213 

was  added  during  the  past  century.  From  1850  to  1890 
Berlin  grew  more  rapidly  than  New  York.  Paris  is  now 
five  times  as  large  as  it  was  in  1800.  Rome  has  increased 
50  per  cent  since  1890.  St.  Petersburg  has  increased 
fivefold  in  a  hundred  years.  Odessa  is  a  thousand  years 
old,  but  nineteen-twentieths  of  its  population  were  added 
during  the  nineteenth  century.  Bombay  grew  from  150,- 
000  to  821,000  from  1800  to  1890.  Tokio  increased 
nearly  800,000  during  the  last  twenty  years  of  the  cen- 
tury ;  while  Asaka  was  nearly  four  times  as  large  in  1903 
as  in  1872,  and  Cairo  has  more  than  doubled  since  1850. 
Thus,  in  Europe,  Asia,  and  Africa  we  find  that  a  redis- 
tribution of  population  is  taking  place,  a  movement  from 
country  to  city.  It  is  a  world-phenomenon."  *^*  And  so, 
also,  is  civilization  becoming  world-wide.  The  growth 
of  cities  and  the  extension  of  at  least  material  if  not 
cultural  civilization,  are  inextricably  intertwined;  and 
with  the  health  of  the  city  the  continuity  and  extension  of 
culture  is  assured.  We  have  solved  the  problem  of  the 
precariousness  of  civilization. 

Will  it  be  possible  to  extend  it  to  lower  latitudes?  In 
order  to  answer  this  question  it  may  be  best  to  refer  to 
what  has  already  been  accomplished  in  those  regions. 
The  Panama  Canal  Zone  was  known  for  centuries  as 
one  of  the  worst  breeders  of  disease,  and  the  French  were 
unable  to  build  the  canal  because  of  this  fact.  They 
not  only  lost  $260,000,000  in  this  fruitless  endeavor,  but 
buried  over  22,000  men  with  an  average  working  force 
of  10,200  in  that  failure.  Their  death  rate  was  240  per 
1.000  during  the  eight  years  of  work.  1881  to  1889.  Under 
American  management  the  total  death  rate  among  the 
employees  of  the  Isthmian  Canal  Commission  and  the 
Panama  Railroad  Company  for  the  calendar  years  since 
work  began  has  been  as  follows :  1904, 13.26;  1905, 25.86; 


214       HEALTH  AND  SOCIAL  PROGRESS 

1906,  41.73;  1907,  28.74;  1908,  13.01 ;  1909,  10.64;  1910, 
10.98;  1911,  11.02;  1912,  9.18.  The  malaria  morbidity 
per  10,000  was  821  in  1906 ;  426  in  1907 ;  282  in  1908 ;  215 
in  1909;  187  in  1910;  184  in  1911 ;  110  in  1912,  and  76 
in  1913.  Meanwhile  the  number  of  employees  increased 
from  82  in  1904  to  50,893  in  1912 ;  and  38,340  of  these 
were  blacks  from  the  West  Indies  and  other  sub-tropical 
countries  where  cleanliness  is  rarely  a  habit  of  the  colored 
population.  This  increased  the  difficulties  of  fighting 
disease,  as  may  be  shown  by  the  fact  that  the  death  rate 
from  disease  for  whites  from  the  United  States  was  only 
3.25,  and  that  of  white  employees  generally  4.62,  as 
against  6.94  for  colored  employees.  The  white  em- 
ployees were,  moreover,  in  many  cases  Spaniards, 
Italians,  and  Cubans,  and  were  not  of  a  particularly  moral 
type,  as  may  be  inferred  from  the  fact  that  of  101  deaths 
from  all  causes  among  them  in  1912,  43  were  due  to 
violence  over  against  58  to  disease.  The  death  rate  for 
the  total  population  of  the  Canal  Zone  has  decreased  from 
49.94  in  1905  to  20.49  in  1912  per  thousand."^  Thus  we 
have  a  material  reduction  in  the  death  rate  from  disease 
in  a  region  which  has  always  been  considered  a  pest 
hole,  and  with  a  population  which  was  not  by  any 
means  the  most  promising  for  an  experiment  of  this 
kind. 

The  Panama  Zone  is,  moreover,  not  the  only  place 
where  results  of  this  kind  have  been  won.  Malaria  ap- 
peared, for  the  first  time  at  Ismailia  in  1877.  From 
August  to  December  there  were  300  cases  out  of  a  popu- 
lation of  10,000.  By  1891  nearly  2,500  cases  were  re- 
ported. The  town  fell  into  decadence  and  the  govern- 
ment offices  were  moved.  With  a  population  of  about 
6,000,  there  were  2,250  cases  of  malaria  in  1900,  1,990  in 
1901,  and  1,548  in  1902,  when  drainage  works  were  estab- 


HEALTH  AND  WORLD-PROGRESS       215 

lished;  the  beneficent  effects  of  these  were  seen  in  the 
reduction  of  malaria  cases  to  214  in  1903,  to  90  in  1904, 
and  to  37  in  1905.  Klang  and  Port  Swettenham,  con- 
tiguous towns  in  the  Federated  Malay  States,  with  a 
population  of  about  4,000  and  an  annual  rainfall  of  100 
inches,  obtained  similar  results.  They  had  510  cases  of 
malaria  in  1900  and  the  number  was  gradually  reduced 
to  23  in  1905.  Hong  Kong  reduced  its  number 
of  malaria  cases  from  1,294  in  1901  to  419  in 
1905."« 

Italy  offers  a  most  interesting  study  in  this  respect. 
The  annual  mortality  from  malaria  used  to  be  about 
15,000,  representing  about  2,000,000  cases  of  sickness. 
In  1902  a  State  monopoly  for  quinine  was  established  to 
insure  the  purity  of  this  medicine  at  a  reasonable  price. 
The  result  may  be  seen  from  the  following  figures; 
1901-02  the  deaths  from  malaria  numbered  13,358.  In 
1902-03,  the  year  following  the  State  monopoly,  4,932 
pounds  of  quinine  were  sold  and  the  deaths  numbered 
9,908;  as  the  use  of  pure  quinine  increased,  the  num- 
ber of  deaths  decreased,  until  in  1906-07  we  have  with 
the  consumption  of  45,591  pounds  of  quinine  only  4,875 
deaths  from  malaria.  Incidentally  the  government  made  a 
profit  of  41,759  pounds  sterling  during  these  five  years.*** 
Many  other  cases,  covering  widely  different  localities  in 
the  tropics  and  elsewhere,  might  be  mentioned;  but  they 
would  merely  illustrate  the  same  point.* 

The  objection  may  be  raised  that  these  results  were 
gained  at  too  high  a  cost  to  make  the  remedy  generally 
applicable  in  the  tropics  and  sub-tropics.  That  is,  how- 
ever, not  the  case.    At  Ismailia  the  initial  costs  of  opera- 

*See  The  Prevention  of  Malaria,  by  Ronald  Ross  (with 
contributions  by  many  physicians)  ;  E.  P.  Dutton  &  Co.,  New 
York,  1910,  pp.  369-575. 


v^\ 


216      HEALTH  AND  SOCIAL  PROGRESS 

tion  were  625  francs,  and  the  annual  expenditure  for 
maintenance  about  2.3  francs  per  head  of  the  population. 
Klang  expended  3,100  pounds  sterling  for  clearing  332 
acres  of  swamp,  and  about  270  pounds  annually  in  the 
campaign  for  health;  Port  Swettenham  spent  7,000 
pounds  sterling  for  clearing  110  acres,  and  about  240 
pounds  per  year  for  upkeep.  The  cost  of  the  sanitary 
provisions  at  Panama  are  variously  estimated.  A  member 
of  the  Isthmian  Canal  Commission,  Mr.  H.  H.  Rousseau, 
estimates  the  total  expenses  of  the  Sanitary  Department 
at  $2,000,000  per  annum,  with  more  than  1,200  men  on  its 
pay  roll  and  including  both  the  curative  and  preventive 
work.  The  total  cost  of  this  department  may  be  about 
$20,000,000  including  sanitation,  quarantine,  and  all  pos- 
sible prophylactic  measures.  That  amounts  to  about 
five  per  cent  of  the  total  cost  of  the  Canal.  This  is 
certainly  a  reasonable  expenditure  when  we  recall  that 
yellow  fever  was  frequent  prior  to  the  beginning  of  this 
work  and  that  as  late  as  1904  about  75  per  cent  of  the 
people  in  the  Zone  were  infected  by  malaria."®  Figur- 
ing $2,000,000  per  year  and  an  average  of  50,000  em- 
ployees for  the  last  five  years — although  it  was  some- 
what smaller — the  cost  per  man  per  day  would  be  some- 
what over  ten  cents,  or  about  $40  per  year.  Dr.  J.  S. 
Lankford  claims  that  the  purely  preventive  work 
averaged  one  cent  per  day  per  man,  and  maintains  that 
this  investment  was  responsible  for  the  low  mortality 
and  morbidity  rates."*  General  Gorgas  himself,  in  a 
paper  read  before  the  American  Society  of  Tropical 
Medicine,  in  June,  1910,  estimated  the  cost  per  capita  per 
day  at  two  and  one-half  cents  for  medical  and  hospital 
treatment,  and  for  sanitation  alone  at  only  nine  mills 
per  day.'" 
The  reason  why  the  estimates  of  cost  of  the  sanitary. 


HEALTH  AND  WORLD-PROGRESS       217 

medical,  and  preventive  work  at  Panama  differ  so  widely 
is  the  complicated  bookkeeping  of  the  government.  Gen- 
eral Gorgas  gives  two  cases  as  illustrations.*  When  the 
President  of  Panama  died  the  medical  department  was 
ordered  to  embalm  the  body.  The  expenses — about  $100 
— were  charged  to  that  department,  but  the  refund  from 
the  family,  amounting  to  more  than  the  costs — was 
credited  to  engineering  and  construction.  Similarly  the 
expenses  for  certain  patients  in  the  hospitals — about  $30,- 
000 — were  charged  to  sanitation;  but  the  receipts  of  the 
Commission  from  them — about  $50,000 — were  credited 
to  construction  and  engineering. 

The  expenditures  cited  are  well  within  the  financial 
ability  of  any  tropical  country  when  its  resources  are  even 
moderately  developed.  It  is  true,  of  course,  that  financial 
considerations  were  not  of  primary  importance  in  the 
vast  majority  of  cases  where  work  of  this  kind  was 
undertaken.  For  administrative  reasons  something  had 
to  be  done  to  reduce  the  appalling  morbidity  and  mortality 
rates,  no  matter  what  the  costs  might  be.  It  has  proved, 
nevertheless,  to  be  good  business. 

General  Gorgas  figures  f  that  if  the  mortality  rate  of 
the  workers  under  the  American  regime  had  been  that 
under  the  French,  there  would  have  been  78,000  deaths 
during  the  ten  years  the  Panama  Canal  was  building  in- 
stead of  the  6,630  which  actually  occurred  with  an 
average  working  force  of  39,000.  It  is  a  question 
whether  the  people  of  our  country  would  have  been  will- 
ing to  have  the  canal  built  under  these  conditions.  The 
sanitary  and  medical  work  saved  the  Canal  Commission 
in  direct  cost  $39,420,000  by  preventing  39,420,000  days 

*  Sanitation   in   Panama,  by   William   Crawford   Gorgas;   D. 
Appleton  &  Co.,  New  York,  191 5,  PP-  239  and  242. 
iOp.  cit.,  p.  283. 


218      HEALTH  AND  SOCIAL  PROGRESS 

of  sickness  among  the  workers.  The  indirect  saving 
was,  of  course,  much  greater. 

It  may  be  in  place  here  to  point  out  that  this  work  of 
making  the  tropics  endurable  for  men  from  higher  lati- 
tudes has  become  possible  only  within  the  last  twenty 
years ;  that  is,  since  the  discovery  of  one  species  of  mos- 
quito as  the  carrier  of  malaria,  of  another  species  as  that 
of  yellow  fever,  and  of  the  discovery  of  the  hookworm, 
coincident  with  the  cause  and  cure  of  other  tropical 
diseases.  So  no  matter  how  skillful  De  Lesseps  may  have 
been  as  an  engineer,  he  could  not  have  completed  the 
Canal  without  sacrificing  many  more  hecatombs  of  men 
to  diseases  at  Panama.  The  cost  in  lives  would  literally 
have  staggered  humanity.  If  we  consider  that  medical 
men  are  just  beginning  to  devote  special  attention  to 
tropical  diseases  and  that  remarkable  results  have  been 
achieved  within  a  short  time,  the  auguries  for  the  future 
are  certainly  propitious.  We  may,  therefore,  expect  to 
accomplish  many  things  in  this  direction,  deemed  impos- 
sible at  present. 

It  will  become  more  necessary  as  time  goes  on  to 
investigate  these  matters  and  to  find  means  for  mak- 
ing the  tropics  more  habitable;  that  is,  more  fit  for 
the  whites  to  live  in  and  for  the  colored  to  work  in, 
since  the  human  race  is  becoming  increasingly  de- 
pendent on  the  warm  countries  for  a  large  part 
of  its  food  supply.  This  is  due  to  two  facts — in- 
crease of  population,  and  greater  need  for  a  varied 
diet. 

The  rapid  increase  of  the  world's  population  may  be 
seen  from  the  following  figures.  The  World's  Almanac 
for  1903  states  that  the  population  of  the  Roman  world 
at  the  time  of  Emperor  Augustus  was  only  54,000,000, 
notwithstanding  great  density  existing  in  some  spots.    By 


HEALTH  AND  WORLD-PROGRESS       219 

1810  it  had  increased  to  only  682,000,000  and  by  1905 
to  about  1,600,000,000.  This  tremendous  increase  in  the 
last  century  was  due  to  various  causes;  e.g.,  discovery 
of  new  lands  which  furnished  an  enormous  food  supply, 
reduction  of  mortality  by  means  of  better  sanitation, 
greater  medical  skill,  fewer  wars,  and  greater  comforts. 
The  earth  is  far  from  being  overpopulated,  since  Raven- 
stein  estimates  it  could  support  207  people  per  square 
mile  with  present  methods  of  production,  whereas  the 
present  density  is  much  below  that,  e.g.,  14.71  for  Africa, 
13.42  for  North  America,  5.19  for  South  America,  59.05 
for  Asia,  111.32  for  Europe,  and  12.2  for  Oceania,  mak- 
ing an  average  of  33.50  per  square  mile  for  the  world. 
True,  only  about  28,269,200  square  miles  of  the  world's 
area  (49,668,000  square  miles)  are  reputed  as  fertile, 
while  4,888,800  square  miles  are  taken  up  by  the  polar 
regions,  4,180,000  square  miles  by  deserts,  and  13,901,000 
square  miles  by  steppes.  This  means  that  the  area  for 
the  polar  regions  has  to  be  deducted  from  the  total  area 
capable  of  supporting  any  people  and  we  may  even  deduct 
the  deserts  for  the  present.  The  steppes,  however,  will 
in  the  course  of  time  become  habitable,  since  we  are  find- 
ing means  to  make  them  yield  an  ample  food  supply 
through  irrigation,  dry  farming,  and  specially  adapted 
crops.  In  the  United  States  alone  about  75,000,000  acres 
may  be  made  available  through  irrigation  and  at  least 
50,000,000  through  dry  farming.  We  are  also  trying 
to  drain  the  100,000,000  acres  of  swamps  within  our 
own  territory — the  most  fertile  land,  by  the  way — ^in 
order  to  support  a  larger  population.  It  has  been  esti- 
mated that  the  swamp,  desert,  and  arid  land  in  the  United 
States  could  well  support  about  100,000,000  people. 
Nevertheless,  if  the  population  increases  at  the  ratio  of 
even  one  hundred  per  cent  in  a  century  instead  of  nearly 


I  "ti 


220       HEALTH  AND  SOCIAL  PROGRESS 

three  hundred  as  in  the  nineteenth  century,  the  food 
supply  will  become  insufficient  in  a  few  hundred  years, 
and  a  larger  demand  will  have  to  be  made  on  the  tropics 
for  additional  food,  notwithstanding  all  possible  increase 
from  additional  lands  recovered  and  from  more  scientific 
cultivation.  The  tropics  have  an  almost  unlimited  capac- 
ity for  increasing  our  food  supply  if  properly  tilled,  owing 
to  the  much  larger  amount  of  heat  the  land  gets  from  the 
sun.  The  land  which  can  grow  two,  thrre,  or  even  four 
crops  a  year  of  different  food  products,  will  and  must 
play  a  large  role  in  the  economy  of  the  world  when  the 
population  has  grown  to  four  or  five  times  its  present 
niunber. 

A  greater  variety  of  food  will  likewise  demand  that 
the  tropics  and  sub-tropics  be  made  habitable.  The  finer 
the  human  organism  becomes,  the  greater  the  variety  of 
food  it  needs.  Primitive  man  might  live  on  uncooked 
herbs,  roots,  and  nuts,  and  perhaps  occasional  raw  meat ; 
but  what  was  his  brain?  Very  little  above  that  of  the 
animals  which  fed  on  the  same  products  of  nature.  Only 
by  better  and  more  regular  meals  was  man  able  to  develop 
a  better  nervous  system  with  its  greater  power  of  coordi- 
nation and  combination.  The  savage  whose  ability  to 
count  only  up  to  three,  and  who  has  to  make  e.g.,  thirty- 
three  payments  for  ninety-nine  sheep,  that  is,  for  each 
three  sheep  separately,  may  be  a  human  being  with 
untold  capacities ;  but  as  a  plain  matter  of  fact  his  abilities 
have  not  been  developed,  and  he  is  far  removed  in  power 
of  combination  from  the  modern  business  man  for  whom 
a  few  millions  are  a  mere  trifle.  This  difference  in  power 
of  coordination  may  be  illustrated  even  within  historic 
times. 

The  greatest  business  man  of  antiquity  was  perhaps 
Job,  with  his  7,000  sheep,  3,000  camels,  500  yoke  of  oxen, 


HEALTH  AND  WORLD-PROGRESS       221 

500  she-asses,  and  a  very  great  household;  so  that  this 
man  was  the  greatest  of  all  the  men  in  the  East,  according 
to  the  Old  Testament.  He  had,  moreover,  the  ability 
to  double  his  whole  fortune  after  the  loss  of  everything 
but  his  perfect  and  upright  character.  But  what  is  he  in 
comparison  with  a  modern  trust  magnate  who  controls 
vast  natural  resources,  numerous  railroads,  banks,  fac- 
tories, even  restaurants — with  all  their  ramifications  in 
civilized  and  even  uncivilized  countries?  He  could  buy 
out  Job  with  a  month's  profits,  or  more  likely  those  of  a 
week.  And  he  may  be  equally  perfect  and  upright  in 
character. 

Take  another  illustration  from  a  different  field  of 
human  enterprise.  Alexander  the  Great  overran  all  the 
countries  of  the  Mediterranean  in  a  few  years  with  about 
30,000  soldiers.  He  had  them  under  his  eyes  practically 
all  the  time,  and  could  instantly  take  measures  to  meet 
the  emergencies  of  a  battle.  In  the  late  Russo-Japanese 
War,  Field  Marshal  Yamagata  had  a  battle  line  usually 
300  miles  in  length,  at  times  500  miles ;  the  details  to  be 
attended  to  were  complex  and  numerous,  as  there  was  a 
constant  shifting  of  positions,  while  aides-de-camp,  tele- 
graphs, and  telephones  brought  messages  continually.  Or 
take  Field  Marshal  von  Moltke  in  the  Franco- Prussian 
War  of  1870-71,  who  had  prepared  his  plans  before- 
hand, and  carried  them  out  in  a  hostile  country  with 
clock-work  precision.  During  the  recent  European  war 
the  powers  of  coordination  had  to  be  larger  still,  with 
war-fronts  of  over  1,000  miles,  all  the  modem  means  of 
communication,  and  armies  of  millions  demanding  atten- 
tion. 

What  an  infinitely  larger  power  of  coordination  over 
varied  and  numerous  factors  is  necessary  in  all  these 
owes  compared  to  the  very  simple  affairs  of  antiquity! 


222      HEALTH  AND  SOCIAL  PROGRESS 

In  speaking  of  the  comparative  mental  capacity  of  the 
ancients  and  the  moderns  we  generally  look  at  subjective 
achievements,  that  is,  those  in  art,  literature,  and  philoso- 
phy; and  since  they  excelled  us  along  these  lines,  we 
hastily  conclude  that  they  were  men  of  a  superior  race. 
We  forget,  however,  that  there  are  giants  in  our  own 
days,  but  in  different  lines  of  activity.  We  have  those 
giants,  too;  compare  a  Michelangelo  in  art,  a  Shake- 
speare in  drama,  a  Kant  or  a  Hegel  with  Socrates  or 
Plato.  But  in  activities  requiring  a  large  power  of  coordi- 
nation, we  are  head  and  shoulders  above  the  Greeks  or 
Romans.  Even  in  comparatively  abstract  matters  we 
excel  them.  Aristotle  is  a  pigmy  beside  Herbert  Spencer, 
and  the  former  is  justly  charged  with  imperturbable 
dogmatism,  owing  to  his  ignorance  of  the  limitations  of 
his  own  knowledge.  Spencer  may  be  dogmatic  at  times ; 
but  his  range  of  knowledge  is  infinitely  broader  than 
that  of  the  Greek  sage,  and  his  power  of  coordinating  a 
vast  amount  of  information  is  very  much  higher,  while 
he  rarely  believes  his  own  propositions  to  be  final.  Com- 
parisons in  other  fields  might  be  made  in  favor  of  the 
moderns,  but  the  few  examples  given  will  serve  to  show 
that  civilization  is  not  retrograding  and  that  man  of  the 
twentieth  century  a.d.  is  at  least  the  equal  of  the  man 
of  the  fifth  century  b.c.  If  civilization  is  measured 
by  the  distance  between  the  agent  and  the  place  of 
action,  we  have  certainly  advanced  since  the  times  of 
Pericles. 

How  did  man  acquire  a  better  nervous  system  ?  Briefly 
stated,  by  better  food,  better  housing  and  clothing,  and 
more  regular  work  and  exercise.  Food  serves  three  pur- 
poses— health,  pleasure,  and  economy;  and  all  three  are 
now  met  in  a  better  way  than  ever  before.  We  eat 
regularly   and   therefore   rarely   overload  the  digestive 


HEALTH  AND  WORLD-PROGRESS       223 

organs,  as  the  savage  frequently  does  owing  to  periods 
of  starvation.    Our  food  is  on  the  whole  nourishing  and 
well  prepared,  and  we   need,  consequently,  a   smaller 
amount  of  it,  unlike  the  nature-peoples,  who  often  eat 
enormous  quantities  of  poor  food  in  order  to  satisfy  their 
craving  for  nourishment.     Improved  housing  and  cloth- 
ing insure  a  more  even  temperature  of  the  blood  without 
drawing  too  much  on  vitality  which  is  necessary  for  other 
purposes.    The  Eskimo,  for  instance,  needs  a  vast  amount 
of  fats  merely  to  maintain  a  proper  temperature  of  the 
blood,  and  a  good  deal  of  energy  is  consumed  in  this 
process,  which  otherwise  might  go  into  the  building  up 
of  a  better  nervous  system  through  improved  digestion 
and  a  more  varied  diet.    More  regular  work  and  exercise, 
possible  only  on  the  basis  of  the  two  conditions  just  men- 
tioned,  likewise  contribute  to  the  growth  of   a  better 
nervous  system.    Any  organ  will  develop  more  perfectly 
if  it  has  regular,  constant  work  and  exercise,  since  dif- 
ferentiations of  finer  organs  are  possible  only  on  that 
basis.    The  fortuitous  "  sports  "  may  have  had  a  role  to 
play  in  evolution,  but  little  dependence  can  be  placed  on 
them;  since  of  necessity  they  appear  very  irregularly, 
and  systematic  development  cannot  take  place  that  way. 
The  only  thing  which  will,  at  least  in  human  society, 
bring  about  progress,  is  regularity  of  work.    And  that  is 
possible  only  with  good  health  as  the  basis  of  a  finer 
nervous  system.    Good  health  is,  however,  dependent  not 
only  on  regularity  of  food  consumption,  better  housing 
and  clothing,  and  regular  exercise,  but  on  a  more  varied 
diet.     That  brings  us  back  to  the  tropics  from  a  new 
point  of  view. 

Even  if  man  in  high  latitudes  had  sufficient  food  of 
the  kind  produced  in  his  own  climate,  history  proves  that 
he  developed  higher  capacities  only  when  he  came  further 


224       HEALTH  AND  SOCIAL  PROGRESS 

south,  or  when  the  south  was,  figuratively  speaking, 
brought  north.  In  other  words,  the  foods  produced  in 
the  north  could  produce  in  combination  with  other  favor- 
able factors  prevailing  there,  a  strong  physique  and  a 
strong  brain,  but  not  a  fine  nervous  system  and  brain. 
The  digestive  organs  were  too  much  burdened,  for  in- 
stance, with  the  assimilation  of  starch  in  northern  lati- 
tudes, and  the  nerve  fiber  could  not  become  as  fine  as  that 
which  was  nourished  on  sugar.  When  these  healthy, 
large-boned,  and  muscular  men  from  northern  climates 
came  south,  they  found  this  very  substitute  for  starch  in 
the  sugar  of  grapes,  figs,  dates,  honey,  and  other  products 
of  warmer  climates.  This  was  a  great  economy  for  the 
digestive  organs,  and  a  larger  surplus  of  energy  was 
created,  which  went  into  the  growth  of  a  finer  nervous 
system,  since  it  was  not  needed  for  meeting  additional 
expenditure  in  the  struggle  for  existence,  owing  to  the 
reduction  of  the  native  population  to  the  condition  of 
slaves,  and  the  consequent  leisure  of  the  conquerors. 
What  is  true  of  sugar  may  apply  to  other  products  of 
warmer  climates,  which  serve  a  necessary  purpose  in  our 
physical  make-up,  but  can  be  had  in  the  north  only  in  a 
roundabout  way  through  heavier  and  less  digestible  foods. 
Man's  remote  ancestor  was  able  to  digest  cellulose,  as  the 
camel  and  the  goat  are  doing  now;  but  he  could  not 
develop  much  mentality,  since  the  process  of  digestion 
required  too  much  energy.  Later  he  secured  starch  in- 
stead of  cellulose  from  fruits  and  grains,  and  the  diges- 
tive organs  were  relieved  of  a  large  amount  of  work  with 
a  consequent  higher  possible  development  of  mind.  Still 
later,  he  consumed  sugar  from  southern  fruits,  and  re- 
lieved his  digestive  organs  still  more,  with  a  consequent 
higher  possibility  of  producing  a  finer  brain.  Thus  there 
is  a  constant  saving  of  energy  in  the  process  of  digestion 


HEALTH  AND  WORLD-PROGRESS    !  225 

from  cellulose  to  raw,  and  later,  cooked  starch,  and  even- 
tually to  sugar,  for  physiologists  have  shown  that  carbo- 
hydrates are  presented  to  the  cells  in  the  form  of  a 
sugar,  both  in  plants  and  animals.  If  a  similar  saving 
is  taking  place  with  other  foods  obtainable  in  the  south, 
we  can  readily  understand  why  the  people  from  the 
north  when  coming  south  were  able  to  have  an  efflores- 
cence of  a  mental  life  unknown  to  them  before,  especially 
as  this  saving  in  energy  was  accompanied  by  contact  with 
a  new  civilization.  Their  diet,  chiefly  nitrogenous  in  the 
north  and  creative  of  initiative,  was  supplemented  in 
many  ways  by  the  lighter  foods  of  the  south,  and  a  more 
economical  and  more  satisfactory  nourishment  of  the 
body  was  possible,  while  social  conditions  suggested  new 
avenues  for  discharging  their  increased  vitality  and  men- 
tality. This  advancement  continued,  however,  only  a  few 
centuries,  as  we  have  seen  before,  owing  to  the  endemic 
diseases  prevalent  in  these  countries,  and  the  civiliza- 
tions thus  created  fell  into  decay.  The  natives  of 
the  warmer  countries  lacked  nitrogenous  food  as  a 
rule,  and  this  circumstance,  combined  with  the  gen- 
eral low  sanitary  conditions  discussed  in  previous 
chapters,  prevented  them  from  developing  a  higher 
mentality. 

With  the  development  of  more  rapid  and  frequent 
transportation  another  solution  has  been  found— to  bring 
the  south  to  the  north  by  importing  the  products  of 
warmer  climates.  The  imports  of  tropical  and  sub-tropi- 
cal products  into  northern  countries  of  Europe  and 
America  has  increased  very  considerably  during  the  last 
30  years.  The  Statistical  Abstracts  of  the  United  States 
for  1912  (p.  557)  and  for  1916  (p.  519)  give  the  follow- 
mg  figures  for  the  import  of  tropical  products  into  this 
country : 


226       HEALTH  AND  SOCIAL  PROGRESS' 


Year  1885 

Spices    22,124,757  lbs. 

Supr   2,717,875.412   " 

Tobacco  leaf.  12,924,265    * 

5>«   119,740,577   " 

Tea  72,104,956  " 

Cocoa 10,300,112   *' 

Coffee    572,599,552   " 

Cotton    5,115,680  " 

India    Rubber  24,208,148  " 

Jn^igo    3.034,650  " 

Licorice  Root  27406,008  " 

Olive    Oil....  493.929 gall. 

^"K    3424,076  lbs. 


Year  1912 

63,116,548  lbs. 
5,998,930,550  '* 
57.740,838  " 
194.737,948  " 
111,406,816  ** 
145.968,945  " 
887,747,823  " 
144,490,745  " 
125,656,386  " 
7.658.067  " 
78,582.225  '' 
5,472,528  gall. 
26,584,962  lbs. 


Year  1916 
82,880,337  lbs. 
7,618,196,085  " 
54,732,098  " 
267,965,948  " 
109,865,935 
243.231,939 
1,203,866,007 

233,135,696 

304,182,814  " 

6,599,583  " 

41,003,295  " 

8.109,375  gall. 
41,925,297  lbs. 


it 
*• 

(( 


These  imports  are  not  luxuries,  as  the  moralists,  ad- 
vocates of   the  "simple  life"  and  of   the  "return  to 
nature,"  would  have  us  believe ;  they  are  absolute  neces- 
sities of  a  higher  physical  and  mental  organization.    Meat 
eaters  may  have  strength  and  initiative,  but  they  become 
nervous;  vegetarians  have  endurance  for  mere  physical 
toil,  but  consume  too  much  energy  in  the  process  of 
digestion  to  develop  self-reliance  and  originality.    "  Not 
only  does  health  of  body  and  mind  depend  upon  the  food, 
but  it  is  built  up  from  childhood,  and  appears  to  be  re- 
sponsible for  the  making  of  man  what  he  is—the  most 
advanced  creation  of  the  animal  world.    While  man  has 
attained   this   station  by   virtue  of   his   intelligence,   we 
shall  show  later  on  that  this  intelligence,  too,  depends 
upon  his  food.    As  a  matter  of  fact,  we  find  that  where- 
ever  man  is  restricted  to  a  sparse,  one-sided  and  incom- 
plete diet,  (and  that  of  most  animals  is  of  this  nature) 
as  are  the  inhabitants  of  many  of  the  southern  islands 
and   the   Bushmen,   his   intelligence   is   likewise  of   the 
lowest  order.     Thus,  the  ancient  Aztecs,  who  already 
cultivated  corn  and  cocoa,  and  lived  on  a  plentiful  and 
varied  diet,  although  principally  a  vegetable  one,  had  a 
well-ordered  state,  with  courts  of  justice  very  similar 


HEALTH  AND  WORLD-PROGRESS       227 

to  our  own.  We  can  also  show,  by  means  of  instructive 
examples  of  which  we  shall  give  several  later  on,  how 
both  man  and  beast  are  made  what  they  are  by  their 
foods."  "*  According  to  the  same  authority  health  is 
likewise  a  matter  of  combating  bacteria.  "  We  eat  in 
order  to  build  up  our  tissues,  we  eat  in  order  to  put  our- 
selves into  condition  to  withstand  the  endless  assaults 
of  lower  organisms  which  attack  us  by  day  and  by  night, 
and  we  also  eat  in  order  that  our  organs,  and  in  par- 
ticular our  brain,  will  be  enabled  rightly  to  perform 
their  functions."  "* 

If  this  reasoning  be  correct,  two  problems  will  be  ex- 
plained. First,  why  disease-ridden  people  cannot  de- 
velop a  strong  body  and  mind ;  second,  why  inadequately 
nourished  people  cannot  develop  a  completely  healthy 
body  and  mind.  The  first  problem  has  been  dealt  with  in 
the  preceding  pages,  and  need  no  longer  be  discussed ;  the 
second  needs  brief  mention  here  for  the  purpose  of  ex- 
plaining the  movements  of  civilization. 

The  peoples  coming  from  northern  latitudes  or  higher 
altitudes  in  the  south  were  unusually  free  from  bacteria, 
which  enabled  them  to  develop  strong  bodies  and  minds. 
They  lived,  however,  chiefly  on  a  meat  diet,  and  developed 
restlessness  and  ambition.  Their  strong  bodies  and  minds 
represented  merely  raw  material  which  required  work- 
ing over  through  a  supplementary  vegetable  diet  and 
contact  with  different  social  organizations  in  southern 
latitudes.  This  opportunity  was  furnished  them  by  their 
migrations  south  or  from  the  mountains  to  the  valleys. 
This  explains  why  these  people  were  the  last  to  be 
reached  by  civilization  in  their  native  home  around  the 
Baltic ;  for  Germany,  Great  Britain,  and  the  Scandinavian 
countries  were  the  last  to  become  civilized.  It  also  ex- 
plains why  these  people  with  their  more  excitable  nervous 


i 


f 


228       HflALTH  AND  SOCIAL  PROGRESS 

organization  fell  victims  more  readily  to  the  various  en- 
demic diseases  in  southern  latitudes,  especially  as  they 
were  without  racial  training  for  them.  In  proportion 
as  these  migrations  became  more  difficult  or  impossible, 
and  transportation  of  southern  products  to  the  north  be- 
came more  frequent  and  regular,  civilization  could  move 
northward.  So  we  find  the  Egyptians  and  Babylonians 
in  almost  direct  contact  with  the  tropics,  but  living  in 
the  sub-tropics ;  later  the  Greeks  and  Romans  in  indirect 
contact  with  warmer  climates;  then  the  Venetians  and 
Genoans,  supplying  the  rest  of  northern  Italy  with  south- 
em  products;  still  later  the  Spaniards,  Portuguese,  and 
French,  who  came  into  more  direct  contact  owing  to  the 
discovery  of  new  sea-routes ;  finally,  the  Dutch,  English, 
Germans,  and  Scandinavians  either  in  direct  or  indirect 
contact  with  the  tropics  and  sub-tropics.  This  contact, 
which  has  now  become  well  established,  is  another  factor 
in  the  permanency  of  civilization,  and  assures  its  con- 
tinuity as  well  as  its  world-wide  character,  since  these 
nations  will  always  depend  on  the  tropics  for  the  supple- 
mentary articles  to  their  prevailing  nitrogenous  diet. 

This  means,  that  the  southern  countries  must  in  turn 
be  made  more  habitable  in  order  to  be  able  to  meet  the 
larger  demands  for  their  products  by  men  in  temperate 
zones.  We  have  seen  what  has  been  done  by  way  of 
sanitation  in  a  very  short  time  at  certain  points  which 
were  looked  upon  for  centuries  as  pest-holes.  It  will  now 
be  necessary  to  point  out  that  the  tropics  need  the  prod- 
ucts of  the  temperate  zone.  The  people  in  the  warmer 
climates  live  principally  on  a  vegetable  diet  which  is  as 
one-sided  as  that  of  the  people  in  the  extreme  north. 
Their  diet  needs,  consequently,  supplementing  with  more 
nitrogenous  foods.  Medical  science  is  agreed  now  that 
a  poorly  balanced  diet  produces  scurvy  on  the  one  hand, 


HEALTH  AND  WORLD-PROGRESS       229 

and  beriberi,  rickets,  and  pellagra  on  the  other.  If  either 
too  much  meat  or  too  many  vegetables  can  produce 
serious  diseases,  it  stands  to  reason  that  a  poorly  balanced 
diet  cannot  produce  a  fine  brain. 

The  opinion  that  but  little  animal  food  is  necessary  in 
warm  climates  has  been  abandoned.  Major  Woodruff,  in 
speaking  about  what  white  men  should  do  in  southern 
latitudes,  says: 

"  This  brings  up  the  question  of  food,  and  it  is  well  to 
say  that  physicians  are  now  almost  unanimous  in  declar- 
ing that  the  old  doctrine  that  we  should  eat  very  lightly 
of  animal  food  in  the  tropics  is  a  very  pernicious  one. 
The  natives  are  now  known  to  be  suflFering  from  nitrogen 
starvation  and  we  should  not  imitate  them  in  this  respect 
any  more  than  we  should  imitate  their  filthy  habits."  ^^' 

We  know  that  General  Gorgas  turned  the  negroes  into 
good  workers  by  a  fair  allowance  of  meat.  The  Japanese, 
too,  have  become  more  efficient  by  resorting  to  a  mixed 
diet,  especially  in  the  navy  and  army.  If  we  want  the 
people  in  the  tropics  to  produce  the  vegetable  food  we 
need,  we  must  supply  them  with  the  animal  food  they 
need,  because  only  in  that  way  will  they  be  able  to  work 
better  and  produce  more. 

The  common  interest  of  men  in  temperate  and  warm 
climates  is  thus  established,  and  it  would  be  well  to 
reckon  with  the  fact  by  taking  a  larger  view  of  our  mutual 
dependence.  Hitherto  our  attitude  toward  men  in  the 
tropics  has  been  one  of  condescension ;  we  have  either  ex- 
ploited them  on  the  more  or  less  explicit  understanding 
that  they  were  inferiors ;  or  we  have  given  them  religion, 
education,  or  free  political  institutions  with  the  idea  that 
this  was  all  they  needed  to  become  like  ourselves.  But  we 
have  never  acknowledged  that  our  relation  to  them  is 
one  pf  mutual  dependence,  and  so  we  have  failed  to  give 


I 


230       HEALTH  AND  SOCIAL  PROGRESS 

them  what  they  most  needed — the  means  to  keep  healthy 
and  to  become  intelligent  workers.  A  beginning  has  been 
made  in  regard  to  proper  sanitation  of  the  tropics,  as  has 
been  shown  above,  and  we  are  just  coming  to  recognize 
the  necessity  of  making  these  people  prosperous  by  a 
more  intelligent  management  of  their  affairs. 

Whether  this  management  is  to  be  by  the  control  of 
white  men,  or  whether  it  is  to  be  intrusted  to  the  colored 
races,  is  a  question  which  cannot  be  answered  finally  at 
present.  In  the  past  the  relation  of  the  whites  to  the 
colored  races  has  usually  been  one  of  parasitism  or  open 
exploitation,  and  this  has  warped  our  whole  mental  atti- 
tude in  regard  to  their  actual  and  potential  capacities. 
The  assumed  natural  and  permanent  inferiority  of  the 
inhabitants  of  warmer  climates  was  a  ready  argument 
with  those  who  wanted  to  profit  from  their  ignorance  and 
inexperience.  And  so  we  find  almost  all  observers  testify 
to  the  laziness,  lack  of  capacity,  shiftlessness,  and  other 
shortcomings  of  the  southern  races.  Practically  all  im- 
perialists are  unanimous  in  this  respect,  but  one  quota- 
tion will  sufficiently  indicate  the  trend  of  opinion.  Judge 
Lambert  Tree,  speaking  of  the  fact  that  white  men  can- 
not live  in  the  West  Indies,  says : 

"  As  the  white  man  loses  his  grip  the  black  man  tightens 
his,  and  hence  is  perceived  everywhere,  substantially, 
negro  control. 

"  Thus,  in  that  precious  republic  Hayti,  the  white  man 
is  not  permitted  to  hold  real  estate,  and  a  number  of  other 
privileges  are  denied  him  which  are  permitted  to  the 
black  citizen.  Judging  from  the  examples  of  negro  rule 
in  Hayti  and  Santo  Domingo,  as  well  as  from  the  social 
and  political  conditions  in  other  of  the  West  Indies  where 
they  are  in  partial  control,  it  would  seem  that  the 
negro  is  3een  at  his  be$t  where  he  is  under  the  influ- 


HEALTH  AND  WORLD-PROGRESS       231 

ence  and  control  of  a  considerable  body  of  the  white 
men. 

"  By  himself,  it  is  nearly,  or  quite,  self-evident  that 
he  is  not  capable  of  administering  government  for  the 
general  welfare  of  the  people  over  whom  he  rules.  The 
negro  is  an  imitator,  and  with  the  influence  and  example 
of  the  white  men  absent,  racial  instincts  beyond  his  con- 
trol seem  to  draw  him  back  as  by  the  *  call  of  the  wild.' 
His  idea  of  government  in  the  republics  in  the  West 
Indies  he  rules  over,  is  to  plunder  the  weak.  *  Might 
makes  right '  is  the  rule  of  the  barbarian,  and  this  is  the 
rule  of  those  whence  he  sprang  and  toward  whom  he  is 
again  drifting.  If  the  negro  is  left  to  himself  much 
longer  in  Hayti  and  Santo  Domingo,  all  government  will 
ultimately  disappear  except  that  of  the  tribal  relation. 
Nothing  is  more  clear  than  that  he  is  retrograding  in  that 
direction."  *^' 

The  picture  drawn  by  Judge  Tree  is  undoubtedly  cor- 
rect, but  the  causes  assigned  are  open  to  question.  He 
is  evidently  convinced  of  the  racial  inferiority  of  the 
negro,  and  that  serves  as  a  sufficient  cause  and  explana- 
tion of  the  present  condition  of  Hayti  and  Santo 
Domingo.  The  same  charge  has  been  made  against 
the  peon  of  Porto  Rico,  against  the  whites  of  the  various 
Central  and  South  American  republics,  of  Mexico,  and 
of  our  own  Southern  States.  Mexico  in  1913  and  1914 
presents  analogous  conditions  to  those  of  the  two  black 
republics ;  yet  there  are  few  negroes  in  Mexico,  and  com- 
paratively few  in  Honduras,  Guatemala,  Costa  Rica, 
Venezuela,  Colombia  or  Peru.  Nevertheless,  Major 
WoodruflF,  who  quotes  Judge  Tree  concerning  Hayti, 
says :  "  Venezuela  is  not  a  republic  at  all,  but  a  turbulent 
mob  without  organization,  because  there  are  not  brains 
to  organize  the  units.    Murder,  pillage,  and  freebooteiy 


I 


i 

! 


Iiiii 


232       HEALTH  AND  SOCIAL  PROGRESS 

dominate  it  from  end  to  end.  Neither  life  nor  property 
are  safe.  Population  and  industry  are  declining.  Inves- 
tors are  excluded  just  when  their  investments  are  to  turn 
out  mutually  beneficial.  It  has  brought  us  to  the  verge 
of  war  more  than  once.  It  is,  then,  not  fanciful  to  pic- 
ture the  United  States  as  the  policeman  of  the  Caribbean 
using  a  '  big  stick  *  to  threaten  the  nations  into  decency. 
It  is  a  living  necessity  of  more  complete  mutual  relations 

in  the  future."  "^ 

Judge  Tree  puts  the  blame  on  race.  Major  Woodruff 
on  the  actinic  rays  of  the  sun,  neither  of  which  factors 
we  are  able  to  control,  and  so  no  other  policy  is  left  but 
that  of  the  "  big  stick."    But  that  policy  has  been  tried 
for  several  hundred  years.    The  negroes  in  the  Caribbean, 
and  the  brown  and  the  red  peoples  all  over  those  and  other 
tropical  regions  have  been  exploited  by  chicanery,  fraud, 
and  force.    At  the  same  time  we  have  sent  our  mission- 
aries and  our  teachers  to  declare  to  them  the  oneness  of 
mankind  and  the  equality  of  all  men.     And  then  we 
wonder  that  they  cannot  reconcile  the  application  of  the 
lash  with  the  offer  of  professed  brotherhood.     Poorly 
nourished   brains   are   the   natural   breeding-places    for 
wild  ideas.     Who  can  blame  these  people— with  blood 
impoverished  through  poor  food,  malaria,  uncinariasis, 
and  in  a  large  number  of  cases  from  venereal  diseases-- 
that  the  wildest  kind  of  ideas  originated  or  took  root  in 
their  poorly  nourished  brains,  when  for  several  centuries 
the  discrepancy  between  our  preaching  and  our  practice 
was  forced  upon  their  attention?    What  but  brutal  re- 
taliation can  be  expected  from  peoples  who,  generally 
speaking,  have  been  subjected  to  all  forms  of  abuse  which 
greed  and  lust  could  invent?    This  is  not  to  justify  but  to 
explain  the  behavior  of  the  Haytians  and  other  peoples  of 
southern  countries  toward  the  white  men  whenever  they 


HEALTH  AND  WORLD-PROGRESS       233 

were  able  to  retaliate.    The  cruelties  perpetrated  upon  the 
Congo  negroes  and  the  Amazonian  Indians  for  the  sake 
of  raw  rubber  are  still  fresh  in  the  memory  of  every 
newspaper  reader.    Who  would  blame  these  people  if  they 
should  rise  and  avenge  themselves  upon  their  oppressors? 
Who  can  blame  them  if  they  loathe  labor  when  it  benefits 
others  only  and  becomes  a  means  of  endless  torture  to 
themselves?    We  have  tried  to  show  previously  what  rad- 
ical changes  often  take  place  in  men  whose  poorly  nour- 
ished brains  could  hardly  contain  the  simplest  ideas  or  else 
gave  rise  to  all  kinds  of  wild  schemes,  after  they  had  been 
freed  from  endemic  diseases.    Would  it  not  be  well  to 
try  a  similar  course  with  other  peoples  before  we  hastily 
pass  judgment  upon  them  as  worthless  and  inferior? 
Wherever  this  has  been  attempted  the  results  have  been 
favorable.     A  quotation  about  a  country  which  Major 
Woodruff  so  severely  condemns  will  perhaps  best  serve 
the  purpose.     An  American  who  closely  observed  the 
people  in  the  Orinoco  region  of  Venezuela  has  written 
to  the  Rockefeller  Sanitary  Commission  this  opinion : 

"  Venezuela  is  a  country  of  marvelous  and  limitless 
natural  resources.  If  the  hookworm  can  be  abolished 
and  these  listless,  lifeless,  almost  worthless  people,  who 
are  in  this  condition  because  of  disease,  can  be  trans- 
formed as  a  young  man  was  whom  I  saw  restored  there 
by  an  English  physician,  into  vigorous,  red-blooded, 
mentally  alive  people,  their  economic  efficiency  can  be 
increased  a  thousandfold  and  the  country  can  be  started 
on  a  career  of  development  which  will  make  a  factor 
in  the  progress  of  the  world. 

"Poorly  nourished  brains  are  the  natural  breeding 
places  for  wild  ideas.  I  believe  that  the  eradication  of 
the  hookworm  will  do  more  than  any  other  one  thing  to 
banish  the  chronic  state  of  revolution  from  the  countries 


!t. 


234      HEALTH  AND  SOCIAL  PROGRESS 

of  Latin  America  and  allow  these  countries  to  attain 
the  prosperity  to  which  they  are  entitled  by  reason  of 
their  natural  resources."  ^^® 

This  quotation  indicates  the  line  which  mutual  relations 
between  peoples  of  the  temperate  zones  and  the  tropics 
should  take.  We  can  give  them  health,  some  of  our  foods, 
and  our  manufactured  articles;  they  can  give  us  their 
foods,  raw  products,  and  such  beverages  as  tea,  coffee, 
and  cocoa.  This  would  be  mutually  advantageous,  and 
the  relation  of  parasitism,  which  we  have  maintained, 
would  change  to  commensalism.  Owing  to  the  gradual 
disappearance  of  the  economic  theory  that  he  is  richest 
who  sells  most  and  buys  least,  we  shall  learn  that  the 
prosperity  of  the  tropics  will  be  to  our  advantage,  for 
they  will  buy  more,  and  our  prosperity  will  enable  us  to 
buy  more  from  them.  We  need  each  other;  and  the 
further  we  advance,  the  more  interdependent  we  become, 
since  the  higher  a  ciznlisation,  the  more  numerous  and 
varied  are  the  factors  of  existence — physically,  mentally, 
and  socially. 

This  law  has  been  applied  to  physical  sustenance,  but 
it  can  easily  be  shown  that  we  owe  a  good  deal  of  our 
understanding  of  our  mental,  moral,  and  social  develop- 
ment to  the  study  of  the  lower  races  still  extant.  The 
study  of  these  peoples  has  been  incomparably  more  fruit- 
ful in  yielding  valuable  results  for  the  history  of  civiliza- 
tion than  that  of  the  few  remains  of  primitive  man  in 
various  parts  of  the  globe.  This  is  especially  true  of  the 
development  of  morality  and  social  customs,  to  both  of 
which  the  finds  in  Java,  in  the  Neanderthal  and  Spy,  or 
elsewhere,  have  contributed  nothing.  On  higher  levels  of 
civilization  we  become  mentally  interdependent,  as  in  the 
sciences  and  many  of  the  arts.  No  nation  is  self-suffi- 
cient in  these  respects,  and  a  discovery  in  France  is  just 


HEALTH  AND  WORLD-PROGRESS    i  233 

as  important  to  Americans  as  one  made  by  our  own 
countrymen.  The  internationalism  of  science  is  estab- 
lished, that  of  commerce  has  begun,  and  that  of  politics 
must  follow.  Only  in  proportion  as  we  are  in  touch 
with  all  nations,  can  we  expand  and  broaden.  And  this 
contact  with  others  must  be  of  a  mutually  beneficial 
nature.  The  old  exploitation  of  nature-peoples  must 
cease,  and  we  must  stop  treating  them  as  inferiors. 

The  question  how  to  control  the  tropics — if  it  is  granted 
that  we  need  them — is  difficult  to  answer,  and  not  a  part 
of  our  discussion.     One  thing  is  certain,  though.     Our 
attitude  toward  tropical  peoples  must  change  if  we  are 
not  to  endanger  our  own  existence.     They  must  be  put 
into  a  condition  to  produce  the  articles  we  need,  and 
that  is  impossible  if  we  continue  to  employ  the  policies 
pursued  in  the  past.     Furthermore,  our  attitude  toward 
the  whole  problem  of  the  inhabitability  of  the  tropics 
must  change.    If  climate  or  intensive  light  is  responsible, 
we  can  do  practically  nothing,  since  these  factors  are 
unchangeable,     or     only     very     slowly     and     slightly 
changeable ;  and  we  must  always  remain,  to  some  extent 
at  least,  slave-drivers  in  the  warm  countries.    With  our 
constantly  growing  population  and  rising  civilization  our 
demands  for  tropical  products  must  of  necessity  increase ; 
and  if  it  be  granted,  that  for  a  number  of  generations  the 
hot  countries  will  be  uninhabitable  for  white  men  and 
that  the  natives  of  these  countries  are  unable  to  escape  the 
enervating  influences  of  the  climate  and  produce  little — 
we  cannot  avoid  the  conclusion  that  the  brown  and  the 
black  races  will  soon  be  exterminated,  through  our  greed 
for  their  products.    If  we  only  take  without  giving  some- 
thing valuable,  these  people  must  die,  as  numerous  races 
have  already  done.    If,  on  the  other  hand,  we  give  what 
we  can  spare,  and  take  what  they  have  in  abundance. 


236      HEALTH  AND  SOCIAL  PROGRESS 

there  is  no  need  of  dreading  the  future,  since  there  will 
be  enough  produced  for  all.  The  white  man  may  then 
stay  in  his  native  clime  and  send  representatives  to  all  the 
tropics  to  guide  the  natives  in  their  industries  and  ex- 
change their  products  for  ours. 

What  we  can  give,  is  health.  We  have  just  begun  the 
study  of  the  factors  which  make  for  health,  and  have 
already  achieved  much.  In  proportion  as  we  study  these 
factors  more  and  attain  better  results,  we  shall  be  able  to 
make  invaluable  contributions  to  the  welfare  and  happi- 
ness of  the  tropical  peoples.  They  will  be  able  to  look 
after  themselves  better,  produce  more,  and  buy  more. 
If  the  results  already  attained  justify  any  conclusion, 
there  would  seem  but  little  doubt  that  we  have  it  in  our 
power  to  make  the  tropics  healthy  at  least  for  the  natives. 
Disease  is  a  factor  which  we  have  learned  to  control  in 
part;  and  we  shall  soon  learn  how  to  do  it  better.  On 
the  basis  of  the  conquest  of  yellow  fever,  malaria, 
typhoid,  uncinariasis,  and  the  bubonic  plague,  it  will  be 
in  our  power  to  re-make  the  tropical  and  sub-tropical 
peoples,  and  bring  their  lands  into  the  service  of  civiliza- 
tion as  fast  as  their  products  are  needed.  This  will  be 
a  long  step  taken  for  the  advance  and  well-being  of  the 
whole  human  race. 

It  is  true  that  our  desire  to  make  the  tropics  healthy, 
will  not  be  sufficient.  But  it  is  true  that  the  results  at- 
tained in  the  control  of  the  endemic  and  epidemic  diseases 
mentioned  justify  the  conclusion  that  we  can  do  it  if  we 
try,  while  it  is  at  least  doubtful  whether  the  heat  and  the 
light  of  those  regions  are  the  cause  of  the  low  physical, 
mental,  and  moral  condition  of  the  inhabitants.  Civiliza- 
tion is  becoming  more  conscious  of  itself,  and,  conse- 
quently, more  telic  in  its  endeavors.  What  used  to  be 
considered   unalterable   factors  *or  immutable  laws  of 


HEALTH  AND  WORLD-PROGRESS       237 

nature,  have  been  found  to  yield  to  intelligent  treatment 
when  we  learned  to  understand  them.  Disease  was  not 
so  long  ago  looked  upon  as  an  important  item  in  our 
moral  training,  and  therefore  inevitable.  We  know  now 
that  it  is  the  very  opposite,  and  avoidable.  In  proportion 
as  we  plan  intelligently  and  analyze  factors  of  life  scien- 
tifically, we  find  that  we  are  making  progress  in  all 
directions.  This  statement  may  be  illustrated  by  the 
attempts  to  lengthen  the  average  life  of  man. 

According  to  the  records  of  the  city  of  Geneva, 
Switzerland,  the  average  span  of  life  was  21.2  years  in 
the  16th  century;  25.7  in  the  17th;  33.6  in  the  18th,  and 
39.7  from  1801  to  1883 ;  while  in  Sweden  at  present  it  is 
50.9  years  for  males  and  53.6  for  females;  and  in 
India  only  23  for  males  and  24  for  females.  One  may 
grant  that  India  is  less  healthy  than  Sweden;  but  the 
fact  that  the  life  span  in  Switzerland  and  in  all  other 
progressive  countries  has  lengthened  so  considerably,  is 
proof  of  what  intelligent  and  progressive  measures  can 
do.  India,  with  its  superstitious  people,  showed  no  ad- 
vance from  1881  to  1901 — 3,  period  fruitful  in  advances 
along  this  line  in  all  European  cotmtries. 

Sweden  is  a  conspicuous  illustration  of  what  can  be 
done  by  a  scientific  view  of  health.  It  has  achieved  most 
because  it  has  looked  upon  the  problem  of  health  as  a 
whole.  In  America  infant  mortality  and  tuberculosis 
have  attracted  wide  attention ;  protection  against  germs 
has  been  given  all  possible  publicity.  Germany  has  paid 
much  attention  to  sanitation  and  a  proper  water  supply. 
Sweden  has  looked  upon  health  as  the  result  of  various 
causes — ^heredity,  sanitation,  diet,  temperance,  exercise, 
personal  hygiene,  instruction;  and  has  emphasized  each 
one  in  proportion  to  its  relative  importance.  The  result 
it  not  only  a  greater  average  length  of  life,  but  a  smaller 


238       HEALTH  AND  SOCIAL  PROGRESS 

death  rate  than  in  any  other  country.    While  reduction 

in  the  death  rate  elsewhere,  e.g.,  in  the  United  States,  is 
due  chiefly  to  a  very  much  smaller  mortality  rate  among 
children  with  an  undiminished,  if  not  increased,  death 
rate  among  persons  just  past  middle  life,  the  improve- 
ments in  Sweden  are  general,  and  the  chances  for  all 
age  classes  are  better.  Infancy,  middle  age,  and  old  age 
show  a  lower  mortality  rate  there  today  than  in  times 
past.  The  Swedes  have  realized  that  even  the  excellent 
opportunities  of  a  healthy  covmtry  may  be  improved  by 
the  application  of  intelligence;  that  it  is  our  duty  and 
privilege  to  be  well  and  happy,  and  to  have  an  abiding 
sense  of  the  beauty  and  nobility  of  a  sound  mind  in  a 
sound  body. 

When  other  nations  begin  to  have  a  simibr  ideal  of 
health  and  try  to  realize  it  by  every  known  means  and 
by  others  still  to  be  discovered,  saner  views  will  be 
entertained  concerning  the  sanctity  of  human  life,  not 
only  in  the  temperate  zones  but  in  the  tropics.  We  shall 
realize  that  there  need  not  be  such  a  tremendous  waste 
of  lives  in  those  regions  for  the  sake  of  a  few  products 
not  obtainable  elsewhere,  and  we  shall  try  to  give  those 
peoples  the  one  thing  which  will  assist  them  in  becoming 
not  only  better  producers,  but  better  men,  parents,  and 
citizens.  This  contribution  of  our  knowledge  will  help 
them  as  well  as  ourselves,  since  in  proportion  as  we  give 
it  to  them,  they  will  be  able  to  return  to  us  the  products 
of  nature,  which  the  tropics  alone  can  produce.  A  gen- 
eral improvement  in  character  is  bound  to  follow  if  our 
statements  and  facts  quoted,  have  any  meaning.  And 
it  is  better  characters  that  mankind  needs  at  present  if 
civilization  is  not  to  halt  but  to  rise  and  spread.  We 
need  more  endurance,  more  patience,  more  forbearance, 
greater  willingness  to  apply  the  laws  of  health  already 


HEALTH  AND  WORLD-PROGRESS       239 

known,  and  optimism  to  believe  that  it  depends  largely  on 
ourselves  whether  we  are  to  be  well  and  happy  through 
productive  work,  and  the  giving  of  our  own  surplus  to 
those  who  give  us  of  theirs.  The  problems  of  nutrition, 
eugenics,  sanitation,  and  personal  hygiene  must  receive 
more  attention  on  the  part  of  intelligent  men  and  women ; 
and  only  social  cooperation  within  the  nations  and  of  the 
nations  with  each  other  is  necessary  to  obtain  good 
health  for  all.  Physicians  are  working  most  unselfishly, 
and  are  performing  ahnost  herculean  tasks  along  this 

line. 

Are  our  statesmen  awake?  Shall  we  have  to  wait 
much  longer  for  a  national  department  of  health?  Con- 
servation of  our  natural  resources  is  being  agitated  in  our 
legislatures  and  congress.  It  is  a  necessity  pressed  upon 
us  by  their  rapid  depletion.  But  the  conservation  of 
human  lives,  the  improvement  of  our  health,  and  the  in- 
crease of  our  vitality  are  certainly  as  important  for  the 
continuation  of  the  nation.  In  the  past  the  fate  of  na- 
tions and  of  armies  depended  on  health;  this  has  been 
the  principal  agency  in  the  re-arrangements  of  the  map 
of  the  world,  and  it  has  always  been  the  most  potent 
factor  in  civilization.  The  varied  activities  of  the  twen- 
tieth century  are  all  of  the  greatest  importance,  but  sani- 
tation contains  the  great  promise  for  the  future. 

"  It  may  be  that  we  are  today  spectators  at  the  begin- 
ning of  one  of  the  most  important  periods  of  history, 
and  are  standing  on  the  threshold  of  an  epoch  that  may 
change  the  standards  of  mankind,  and  establish  new 
limits  for  human  achievement. 

"  It  is  also  possible  that  this  period  may  mark  the  dawn 
of  a  new  civilization,  wherein  the  conservation  of  the 
health  of  the  individual  is  a  basic  principle;  a  civiliza- 
tion that  recognizes  that  the  highest  development  of  the 


240      HEALTH  AND  SOCIAL  PROGRESS 

race  depends  upon  the  health  of  its  members  and  that 
progress  and  science,  the  arts,  commercial  achievement, 
and  other  fields  of  activity,  are  limited  by  the  physical 
capabilities  of  its  people.  What  the  results  of  this  great 
movement  will  be,  no  man  can  fully  predict.  That  its 
effect  upon  the  nation  will  be  profound,  there  seems  to  be 
no  question ;  but  who  will  attempt  to  mark  the  confines 
of  its  effectiveness,  or  prescribe  the  boundaries  of  its 
influence?""* 


t. 


•■/ 


CHAPTER  XIII 

HEALTH  AND  ORIGINALITY 

Whatever  view  one  may  take  concerning  the  origin 
of  genius,  the  influence  of  the  men  who  possessed  it 
cannot  be  denied.  Whether  those  men  are  looked  upon 
as  insane,  as  by  Nisbet ;  as  degenerates,  as  by  Lombroso 
and  his  school ;  or  whether  they  are  considered  the  quin- 
tessence of  a  nation,  one  fact  stands  out  prominently — 
they  have  influenced  history  profoundly.  Among  savage 
tribes  they  were  chiefs  and  warriors;  among  the  semi- 
dvilized,  founders  of  religion  and  of  crude  philosophy; 
among  civilized  peoples  they  are  military  commanders 
and  statesmen,  artists  and  philosophers,  men  of  letters  and 
of  science.  Their  influence  has  entered  every  sphere  of 
life,  and  they  win  the  admiration  of  their  fellowmen  by 
striking  out  into  new  paths,  in  some  cases  owing  little 
to  education,  in  many  cases  arising  from  the  most  humble 
environments  and  fighting  their  way  against  numerous 
obstacles  into  positions  of  prominence  among  their  con- 
temporaries and  posterity.  It  will,  therefore,  be  neces- 
sary to  treat  genius  briefly  from  the  point  of  view  of 
heahh,  to  discover,  if  possible,  whether  the  leaders  of 
civilization  have  been  healthy  men,  or  whether  they 
have  been  diseased.  The  question  of  civilization  is 
rather  closely  connected  with  that  of  genius,  if  once 
the  tatter's  influence  upon  history  has  been  ad- 
mitted. 

If  civilization  is  the  product  of  healthy  peoples,  the 
leaders  must  have  been  healthy  men.    This  conclusion  is 


HEALTH  AND  ORIGINALITY 


243 


242      HEALTH  AND  SOCIAL  PROGRESS 

inevitable,  if  the  facts  on  the  preceding  pages  have  any 
meaning. 

Genius  means  an  extraordinary  capacity  for  making 
syntheses.  This  definition  will  cover  all  kinds  of  geniuses 
as  they  have  appeared  in  history  and  influenced  the  fate 
of  nations.  The  material  used  by  genius  may,  however, 
be  of  two  kinds ;  it  may  be  developed  chiefly  from  within, 
as  a  result  of  a  lively  imagination ;  or  it  may  be  the  result 
of  observation  and  study  of  facts.  This  gives  us  what 
may  be  called  subjective  and  objective  genius.  It  would 
be  impossible  to  draw  a  clear  line  of  demarcation  between 
the  two  types,  just  as  it  is  extremely  difficult  to  dis- 
tinguish the  anthropological  races  sharply  from  each 
other.  In  a  general  way  the  distinction  holds,  however; 
and  an  attempt  will  be  made  to  make  it  clear. 

The  genius  has,  then,  an  extraordinary  capacity  for 
synthesizing  in  the  meaning  of  Kant,  i.e.,  the  organiza- 
tion of  the  manifold,  whether  of  external  or  internal  sen- 
sation, under  some  unifying  principle.  In  proportion  as 
this  capacity  is  general,  the  genius  is  of  the  highest  type 
and  covers  several  fields,  like  Leonardo  da  Vinci,  who 
was  painter,  sculptor,  architect,  musician,  mechanical  en- 
gineer, and  natural  philosopher.  In  proportion  as  it  is 
specific,  genius  is  confined  to  one  particular  line  of  work 
with,  perhaps,  corresponding  lacuncc  of  knowledge  in 
other  lines;  like  Turner,  who,  according  to  Nisbet, 
"  stands  alone  as  an  example  of  a  surpassing  faculty 
for  color,  combined  with  the  lowest  intellectual 
powers." "®  Between  these  two  extremes  there  are 
numerous  intermediary  stages  which  it  is  not  necessary  to 
follow.  It  is  more  important  to  show  what  genius  is, 
biologically  and  sociologically. 

Genius  is  a  useful  variation  and  constitutes  the  few 
outlying  members  of  an  orderly  series,  the  members  i 


the  group  diminishing  in  number  according  to  determined 
laws  as  the  degree  of  eminence  or  divergence  from  the 
average  increases.  If  this  statement  is  true,  we  should 
expect  that  the  greater  the  genius,  the  better  health  its 
possessor  must  have.  What  then,  do  we  find  in  this 
respect?  It  may  be  convenient  to  select  a  few  men  whose 
genius  is  universally  recognized.  Omitting  the  ancients 
owing  to  the  scarcity  of  reliable  data  concerning  them, 
we  may  begin  with  modern  men. 

A  few  remarks  must  be  made,  however,  before  wc 
proceed  to  these  men.  If  we  remember  that  health  is  not 
necessarily  identical  with  robust  strength  or  athletic 
and  muscular  development  but  rather  with  sound  morpho- 
logical structure  and  physiological  function,  we  shall 
see  that  a  number  of  men  come  under  the  heading  of 
** healthy"  who  do  not  pass  ordinarily  as  strong  men. 
Vitality  is  more  important  than  muscular  development 
or  brute  strength;  ability  to  resist  small  but  constant 
ailments  is  a  better  measure  of  health  and  vitality  than 
ability  to  lift  weights  or  run  a  Marathon  race ;  and  regu- 
lar mental  exertion  is  a  better  index  to  brain  power  and 
general  physical  endurance  than  mere  physical  labor  for 
eight  or  ten  hours  a  day.  That  the  strain  from  brain 
work  is  a  greater  tax  on  the  constitution  may  be  inferred 
from  the  fact  that  more  brain  workers  break  down  than 
day  laborers.  Formerly  such  men  were  poets,  artists, 
philosophers,  and  scientists;  business  men  and  manual 
workers  were  comparatively  free  from  collapse.  When 
business  began  to  partake  more  of  the  nature  of  mental 
exertion,  the  number  of  breakdowns  among  business  men 
increased  rapidly ;  and  the  same  thing  is  happening  with 
manual  laborers  when  their  work  requires  not  so  much 
strength  as  close  attention  to  a  machine  or  the  manipula- 
tion of  a  few  deft  but  continuous  and  exact  movements. 


244       HEALTH  AND  SOCIAL  PROGRESS 

It  is  the  constant  effort  along  a  particular  line  and  the 
continuous  exertion  of  a  particular  organ,  which  is  more 
detrimental  than  general  physical  labor,  although  heavy. 
There  is  more  rest  in  the  latter  case  for  all  organs  owing 
to  the  change  in  occupation.     For  the  specialist,  which 
the  mental  worker  has  always  been,  this  rest  is  impos- 
sible; hence  more  frequent  breakdowns  among  this  class 
of  workers  were  unavoidable,  although  deplorable,  at  a 
time  when  the  human  machinery  was  less  understood 
than  at  present,  and  when  the  mind  was  considered  to 
be  independent  of  the  body.    The  general  neglect  of  the 
commonest   rules  of  health  among  mental  workers   is 
one  of  the  saddest  chapters  in  the  history  of  intellectual 
development,  and  the  recognition  of  the  interdependence 
of  sound  mentality  and  sound  corporeity  is  one  of  the 
greatest  advances  made.     In  proportion  as  this  principle 
came  to  be  adopted,  the  lamentable  failures  in  health 
among  mental  workers  decreased  in  frequency,  since  these 
men  are  now  among  the  healthiest  specimens  of  the  race, 
and  knowledge  of  a  socially  useful  kind  has  advanced 
proportionately.    In  looking  over  the  history  of  geniuses 
and  other  mental  workers,  we  should  remember  this  fact 
concerning  the  general  neglect  of  the  body.     Even  the 
most  robust  constitution  must  become  weakened,  if  not 
ruined,  by  the  abuse  of  the  body;  and  the  result  is  in- 
evitable— vagaries  and  the  wildest  kinds  of  superstitions 
outside  of  the  regular  vocation  of  the  scholar ;  e.g.,  New- 
ton's ideas  on  religion  in  the  Apocalypse. 

Another  thing  which  should  be  borne  in  mind  before 
judging  geniuses  as  insane  or  degenerate,  is  the  love  of 
these  men  for  their  work.  Whenever  anyone  becomes 
too  much  interested  in  his  vocation,  overexertion  in  its 
pursuit  is  apt  to  occur.  Perhaps  no  work  is  as  fascinat- 
ing as  mental  work,  at  least  to  those  who  are  inclined 


HEALTH  AND  ORIGINALITY 


245 


that  way.    The  result  is  absorption  to  the  extent  of  not 
only  neglecting  the  body  by  denying  it  proper  rest  and 
food,  but  abusing  it  by  too  much  strain  in  the  line  of  one's 
specialty.     The  constant  use  of  one  particular  organ 
may  strengthen  it,  but  at  the  expense  of  other  organs; 
these  will  in  consequence  become  weaker  and  unable 
to  do  their  work  properly,  and  their  gradual  deteriora- 
tion must  eventually  produce  a  weakening  of  the  constitu- 
tion as  a  whole,  including  the  organ  strengthened  at  the 
expense  of  the  others.    A  slight  irregularity  in  the  con- 
struction of  the  most  used  organ  will  often  cause  a 
tremendous   strain  not  only  on  the  organ   itself,  but 
through  it  on  the  whole  body,  because  the  organ  is  handi- 
capped and  is  called  upon  to  do  perfect  work  with  an 
imperfect  instrument.  This  is  particularly  the  case  with 
the  eyes,  which  during  waking  hours  have  practically  no 
rest,  especially  in  the  case  of  near-workers  who  have  to 
concentrate  vision  on  small  objects,  and  often  require 
great  precision  of  vision  for  the  proper  performance  of 
their  duties.  A  slight  astigmatism  in  such  a  case  may 
produce    a  heavy  strain  on  the  whole  nervous  system, 
as  Dr.  George  M.  Gould  has  pointed  out.^»^    If  to  this 
near-work  with  the  eyes  there  is  added  the  strain  of 
continual  deep  thinking,  the  nervous  system  is  kept  in 
a  constant  tension  and  must  eventually  give  way,  or 
must  at  least  suffer.    Dr.  Gould  explains  the  poor  health 
of  many  men  of  genius  and  the  physical  ruin  of  others 
through  this  strain  of  poorly  constructed  eyes,  which  in 
former  times  could  not  be  relieved  by  proper  glasses  ow- 
ing to  ignorance  of  how  to  correct  numerous  and  often 
purely  individual  refractions.    Among  the  men  he  dis- 
cusses are  De  Quincy,  Carlyle,  Darwin,  Huxley,  Brown- 
ing, George  Eliot,  Wagner,  Parkman,  Herbert  Spencer, 
and  Nietzsche.    While  physicians  generally  declare  Dr, 


246       HEALTH  AND  SOCIAL  PROGRESS 

Gould  to  be  an  extremist,  he  had  the  indorsement  among 
others  of  the  nerve  speciaHst,  Dr.  Weir  Mitchell.  That 
constant  although  slight  irritations  may  cause  serious 
effects  was,  however,  brought  out  at  the  meeting  of  the 
International  Surgical  Association  in  New  York  by  Dr. 
A.  J.  Ochsner  of  Chicago  and  by  Dr.  William  J.  Mayo, 
of  Rochester,  Minn.  The  former  in  particular  claimed 
that  constant  irritations  may  and  do  cause  cancer  of  the 
stomach.* 

We  have  here  a  parallel  case  to  that  discussed  in  pre- 
vious chapters  concerning  the  cumulative  effects  of  en- 
demic diseases  which  do  not  kill,  but  vitiate  vitality 
through  constant  interference  with  vital  functions  by 
almost  uninterrupted  nagging  and  irritation.  As  there, 
so  here  we  may  explain  many  effects  on  civilization  by 
means  of  small  defects.  There  we  had  the  endemic 
diseases  which  prevented  men  from  reaching  a  full  and 
vigorous  manhood;  here  we  have  in  many  cases  specific 
small  ailments  which  sometimes  warp  an  otherwise  strong 
mentality,  and  sometimes  prevent  a  full  development  of 
social  usefulness. 

These  facts  are  referred  to  in  order  to  show  that  some 
men  of  genius  who  were  afflicted  with  maladies  may  have 
had  good  heredity,  that  the  structure  of  their  bodies  was 
good,  and  that  some  particular  small  ailment  which  went 
uncorrected  either  through  ignorance  or  negligence  was 
responsible  for  many  breakdowns  and  infractions  of 
logic  and  social  conventions. 

Nisbet  and  Lombroso  forget  to  take  social  conditions 
into  account  when  they  charge  men  of  genius  with  oddi- 
ties and  disregard  of  social  rules.  Even  a  great  man  is  still 
a  human  being  and  subject  to  the  foibles  and  follies  of  his 
times.    Greatness  must  exert  itself  along  the  current  social 

*Mf(iicQl  Record,  New  York,  April  25,  1914,  p.  77^ 


HEALTH  AND  ORIGINALITY 


247 


channels.  In  the  Middle  Ages  most  men  of  talent  went 
into  the  service  of  the  church  either  directly  as  monks  and 
priests  or  indirectly  as  artists  and  architects.  During 
the  Napoleonic  era  most  of  such  men  went  into  the  army 
because  the  rewards  were  highest  in  that  service.  In 
our  own  times  the  most  energetic  men  go  into  business. 
As  in  great  things  so  in  small.  If  a  particular  society  ex- 
pects the  genius  to  be  odd  and  unkempt,  he  will  accommo- 
date his  fellowmen  and  become  a  mendicant  monk;  if  it 
expects  him  to  exhibit  his  power  by  splendor  and  ostenta- 
tion, he  will  build  magnificent  palaces  and  adorn  himself 
with  gorgeous  robes ;  if  it  wants  him  to  be  a  "  Bohemian," 
he  will  be  wild  and  reckless  in  his  speech,  dress,  and 
manners;  if  it  wants  him  to  live  a  proper  life  as  other 
mortals  do,  he  will  submit  to  social  conventions.  A 
genius  becomes  more  amenable  to  social  proprieties  in 
proportion  as  other  men  demand  that  he  should  act  like 
others  instead  of  one  exempt  from  human  laws.  Many 
things  were  not  only  forgiven  the  genius  in  the  past,  but 
were  directly  expected  of  him  for  which  a  more  proper 
and  conventional  age  would  condemn  him.  Let  us  now 
consider  ten  men  of  genius  from  the  point  of  view  of 
health. 

Among  naturalists  we  have  Darwin  and  Spencer.  The 
former  is  reckoned  even  by  Lombroso  among  sane  men 
of  genius.  Darwin  lived  to  be  73  years  of  age.  He  had 
inherited  a  strong  constitution,  as  is  proved  by  the  fact 
that  he  "wasted"  his  time  at  Cambridge  by  shooting, 
hunting,  riding,  and  sporting,  and  was  in  excellent  health 
and  high  spirits.  Whether  it  was  his  five  years*  journey 
on  the  Beagle,  or  the  constant  trouble  with  his  eyes  which 
interfered  with  his  health,  it  is  impossible  to  determine 
now.  He  suffered,  however,  from  nervous  weakness  the 
rest  of  his  life,  but  managed  by  careful  limitation  of  his 


I''il 


im 


m 


248       HEALTH  AND  SCKIAL  PROGRESS 

studies  and  by  the  removal  of  all  unnecessary  distrac- 
tions to  accomplish  work  not  only  comparatively  large  in 
quantity,  but  very  high  in  quality.  A  man  who  could 
write  of  himself  in  his  old  age,  after  having  been  recog- 
nized as  the  foremost  scientific  man  of  his  times,  the 
words  following  must  have  had  an  almost  perfect  poise 
and  balance,  resulting  from  good  physical  structure. 
"  My  success  as  a  man  of  science,  whatever  this  may 
have  amounted  to,  has  been  determined,  as  far  as  I  can 
judge,  by  complex  and  diversified  mental  qualities  and 
conditions.  Of  these  the  most  important  have  been — ^the 
love  of  science — unbounded  patience  in  long  reflecting 
over  any  subject — industry  in  observing  and  collecting 
facts, — and  a  fair  share  of  invention  as  well  as  conunon 
sense.  With  such  moderate  abilities  as  I  possess,  it  is 
truly  surprising  that  I  should  have  influenced  to  a  con- 
siderable extent  the  belief  of  scientific  men  on  some  im- 
portant points."  *•* 

Herbert  Spencer  had  a  remarkable  vitality,  as  is  shown 
by  the  fact  that  at  the  age  of  thirteen  he  became  home- 
sick at  school  and  started  one  morning  at  six  for  home, 
walking  48  m3es  the  first  day,  47  the  second,  and  20  the 
third,  with  very  little  food  during  the  three  days.  He 
was  a  good  runner  and  skater  as  a  boy.  As  a  draughts- 
man at  twenty-one  he  worked  from  eight  in  the  morning 
to  twelve  at  night  and  one  day  a  week  he  worked  till  three 
in  the  morning,  keeping  at  this  schedule  for  several  years. 
This  strain  resulted  in  a  nervous  breakdown  at  the  age  of 
thirty-five,  but  he  continued  in  fair  health  until  sixty-two, 
when  he  had  to  shorten  his  customary  long  walks.  A 
man  who  lived  to  the  age  of  eighty-three,  and  wrote  such 
a  large  quantity  and  of  good  quality,  whose  range  of 
knowledge  was  so  encyclopaedic — must  have  had  an  ex- 
cellent constitution,  such  as  could  be  ruined  only  by 


HEALTH  AND  ORIGINALITY 


249 


utter  disregard  of  all  rules  of  health.  But  it  responded 
quickly  as  soon  as  Spencer  began  to  take  better  care  of 
himself;  otherwise  he  could  not  have  accomplished  the 
work  he  did.  Mention  should  be  made  here  of  A.  R. 
Wallace,  perhaps  equally  prominent  as  a  naturalist,  who 
passed  the  age  of  ninety  years,  but  kept  vigorous  in  body 
and  mind  till  very  near  his  death. 

Among  the  philosophers,  Kant  and  Hegel  are  the  most 
prominent  in  modem  times.  Of  the  former  we  read: 
**  He  enjoyed  good  health,  was  absolutely  regular  in  his 
daily  habits,  free  from  the  cares  of  family-life,  and,  for 
three-quarters  of  a  century,  devoted  to  science  and  intel- 
lectual pleasures."  **'  He  lectured  at  the  university  until 
seven  years  before  his  death,  lived  to  be  eighty  years  of 
age,  was  cheerful  in  temperament  and  social  in  disposi- 
tion. Hegel  lived  only  sixty-one  years.  Lombroso  does 
not  mention  him,  and  Nisbet  only  states  that  his  sister 
was  insane,  but  does  not  give  the  cause.  H^el  was  never 
a  strong  man,  but  neither  was  he  sick.  His  vitality  was 
what  is  technically  called  "medium,"  and  with  good 
care  of  his  health  he  was  able  to  keep  very  busy,  accom- 
plishing a  remarkable  amount  of  work  of  the  highest 
order.  I  have  found  only  one  reference,  in  Ktmo 
Fischer's  volimies,  to  Hegel's  health  when  he  was  pro- 
fessor in  Berlin :  "  Die  f  riih  gealterte  Figur  war  gebeugt, 
doch  von  urspriinglicher  Ausdauer  und  Kraft."  ^**  When 
about  sixty-one  years  old  he  began  his  winter  lectures 
with  a  fire  and  energy  which  surprised  his  hearers,  but 
died  in  November  of  that  year  (1831)  of  cholera,  which 
proved  almost  invariably  fatal  in  those  days. 

Of  modern  poets  Shakespeare  and  Goethe  are  among 
the  foremost.  Lombroso  is  silent  concerning  the  bard 
of  Avon,  but  Nisbet  says :  "  Shakespeare's  perceptions 
must  have  been  extraordinarily  keen  and  persistent.    His 


i 


250       HEALTH  AND  SOCIAL  PROGRESS 

mind  must  have  photographed  everything  he  saw.  Na- 
tural scenery,  natural  objects,  human  character,  society 
and  its  usages — all  must  have  been  vividly  impressed  upon 
his  brain,  and  there  associated  with  extensive  and  hardly 
less  vivid  memories.  Had  we  known  the  man  we  should 
probably  have  discovered  that  he  had  limitations.  All 
we  can  gather  from  his  writings  is  that  his  surroundings 
must  have  impressed  him  with  a  force  out  of  all  propor- 
tion to  the  attention  he  could  have  given  them,  and  that 
his  impressions  being  retained  must  have  furnished  him 
with  an  enormous  amount  of  intellectual  material  and  a 
basis  of  comparison  infinitely  greater  than  that  possessed 
by  ordinary  men.  He  seems  to  have  been  untraveled, 
and  to  have  had  but  a  moderate  knowledge  of  books ;  yet 
by  dint  of  acquisitions — ^mainly  visual  in  their  origin,  but 
extensively  cohering  together  and  thus  creating  a  great 
identifying  or  constructive  faculty — ^he  was  able  to  people 
foreign  scenes  and  the  ancient  world  with  appropriate 
characters,  and  to  supply  them  with  incidents  to  match. 
Such  immense  creative  power  as  Shakespeare's  can  only 
be  understood  in  connection  with  a  morbid  impression- 
ability." ^" 

In  the  sixth  chapter  of  his  book,  Nisbet  bases  his  con- 
clusion as  to  the  insanity  of  "  the  greatest  poet  that  the 
world  has  seen  "  on  the  alleged  great  mortality  of  Shake- 
speare's family,  on  his  supposed  paralysis,  and  the  incom- 
petence of  his  brothers.  It  may  be  well  to  remember  here 
what  was  said  above  about  the  influence  of  social  con- 
ditions upon  genius.  Those  were  the  days  of  "  merrie 
England,"  and  there  is  no  reason  to  expect  that  this 
dramatist  did  not  enter  into  the  spirit  of  his  times  with 
all  the  zest  of  a  man  who  wants  to  enjoy  himself  and 
find  what  is  known  as  "  copy  "  in  modem  parlance.  Be- 
ing engaged,  moreover,  in  so  many  capacities, — actor* 


HEALTH  AND  ORIGINALITY 


251 


playwright,  poet,  stage  manager  and  boon  companion, — 
it  would  be  a  miracle  if  he  had  lived  over  fifty-two  years 
under  the  generally  unsatisfactory  conditions  of  sanita- 
tion of  those  times.  That  he  must  have  worked  hard 
and  managed  well  is  shown  by  the  fact  that  at  the  age  of 
thirty-seven  he  bought  a  house  and  garden  in  New  Place, 
London,  and  at  forty-eight  he  was  able  to  buy  a  free- 
hold house  at  Black  friars  for  145  pounds,  and  to  retire 
to  Stratford  as  a  squire,  which  implied  that  he  had  at 
least  a  fair  amount  of  property.  Remuneration  for  any 
of  the  activities  in  which  Shakespeare  engaged  was  rather 
meager  in  those  days,  and  the  accumulation  of  a  fair 
fortune  in  London  by  a  runaway  country  boy  indicates 
a  good  amount  of  common  sense  in  addition  to  constant 
work. 

In  regard  to  the  alleged  great  mortality  of  the  family, 
the  records  tell  a  different  story.  The  poet  was  one  of  a 
family  of  eight,  two  of  whom  died  in  infancy,  and  the 
others  reached  the  following  ages:  William,  52;  Gilbert, 
46;  Joan,  17  \  Annie,  8;  Richard,  39;  Edmund,  27.  As 
the  ages  of  the  two  infants  are  not  given,  we  have  249 
years  for  the  combined  age  of  the  other  six;  divided 
among  the  eight  children,  we  get  a  little  over  31  as  the 
average  age  for  the  eight.  This  compares  favorably 
with  the  average  age  in  Geneva,  Switzerland,  which  had 
an  average  age  of  21.2  years  in  the  16th  century,  and 
25.7  in  the  17th  century.  If  we  omit  the  two  infants, 
we  have  an  average  of  41.5  years  for  the  six  children 
who  survived — which  compares  well  with  Prussia's 
average  of  41.0  for  males  and  44.5  for  females  during  the 
period  of  1891  to  1900.  That  two  out  of  eight  children 
died  in  infancy  is  not  an  argument  for  poor  vitality  of 
the  parents,  since  the  perils  of  infancy  were  infinitely 
greater  at  that  time  than  they  are  at  present  in  civilized 


,iU 


252       HEALTH  AND  SOCIAL  PROGRESS 

countries.  If  the  general  infant  mortality  of  England  at 
that  time  had  been  that  of  the  Shakespeare  family  it 
would  have  been  250  per  thousand;  this  compares  well 
with  Austria's  227  dunng  the  decade  of  1893  to  1902, 
and  very  favorably  with  Russia's  272  and  Chile's  333 
during  the  same  years.  William's  only  son,  Hamnet, 
died  at  the  age  of  twelve,  but  his  two  surviving  daughters 
reached  the  age  of  66  and  17,  respectively.  Through  his 
sister  Joan,  the  Shakespeare  family  is  known  to  have  ex- 
tended over  nine  generations,  the  last  known  survivor, 
George  Hart  of  Birmingham,  having  emigrated  to  Aus- 
tralia in  1864.  Considering  all  circumstances,  the  vitality 
of  the  Shakespeare  family  is  above  the  average  of  their 
time ;  and  remembering  the  condition  of  sanitation  and  of 
medical  knowledge,  and  the  social  customs  of  those  days, 
it  is  evident  that  the  mortality  of  the  family  was  cer- 
tainly not  greater  than  that  of  the  well-situated  classes  of 
the  time.  William  must  certainly  have  had  a  good  consti- 
tution to  do  all  the  work  credited  to  him,  and  to  gain  a 
competency  at  a  poorly  paying  occupation;  all  this  re- 
quired balance  and  good  management. 

About  Goethe  we  have  more  definite  data.  "  He  was 
a  man  of  genius  distinguished  by  the  comprehensive  char- 
acter of  his  ability.  He  was  a  poet  and  dramatist  of  the 
highest  rank,  his  mind  was  stored  with  the  most  varied 
knowledge,  and  he  contributed  to  the  advancement  of 
natural  science.  As  minister  of  state  and  as  director  of 
a  theater,  he  was  occupied  with  practical  affairs. 

"  He  reached  the  age  of  eighty-three  years,  and  he 
passed  through  the  phases  of  life  in  relatively  normal 
circumstances;  in  his  many  writings  there  are  most 
valuable  facts  which  throw  a  keen  light  on  his  life  and 
nature."  ^^ 

He  was,  with  the  exception  of  comparatively  short 


HEALTH  AND  ORIGINALITY 


253 


periods  in  his  life,  a  healthy  man,  and  maintained  his 
physical  and  mental  vigor  to  the  very  last,  finishing 
"  Faust  "  less  than  a  year  before  his  death.  His  strength 
and  vitality  were  prodigious,  and  the  balance  of  functions 
remarkable.  His  contemporaries  agree  that  even  in  his 
old  age  he  was  still  beautiful;  and  in  his  seventy-fifth 
year  he  walked  for  several  hours  at  a  time,  forcing  the 
pace  and  exhibiting  an  amount  of  strength  which  filled 
Eckermann,  his  companion,  with  delight 

Leonardo  da  Vinci  was  a  person  of  splendid  physique, 
outstripping  younger  men  in  feats  of  strength,  and  zealous 
in  his  multitudinous  activities ;  he  lived  to  be  nearly  sixty- 
seven  years  of  age ;  and  even  Lombroso  is  unable  to  count 
any  aberrations  against  him. 

Michelangelo  was  ascetic  in  his  habits,  worked  with 
furious  intensity  up  to  his  seventieth  year,  and  then  had 
enough  energy  left  to  plan  and  carry  forward  great  archi- 
tectural works  like  St.  Peter's  in  Rome.  As  poet,  painter, 
sculptor,  and  architect  he  not  only  excelled  most  of  his 
contemporaries,  but  is  one  of  the  few  masters  whose 
genius  is  of  the  very  highest,  retaining  full  possession  of 
his  faculties  until  his  death  in  the  ninetieth  year  of  his 

life. 

Lombroso  "^  has  two  objections  to  the  soundness  of 
his  mind.  One  is  his  "  complete  indifference  "  to  women ; 
the  other,  his  religiosity  in  old  age.  In  regard  to  the 
first  supposed  shortcoming,  Lombroso  admits  the  exis- 
tence of  at  least  two  letters  indicating  that  the  artist  was 
capable  of  ardent  love  for  women ;  this  in  addition  to  the 
sonnets  which  mention  women.  The  interesting  thing  in 
this  connection  is  the  absence  of  any  mention  of  Kant's 
supposedly  defective  genius  on  this  score.  In  regard  to 
Michelangelo's  religiosity,  the  only  statement  which  needs 
to  be  made  is  Lombroso's  omission  to  consider  the  spirit 


254       HEALTH  AND  SOCIAL  PROGRESS 

of  the  time  and  social  customs.  When  everybody — ^not 
excluding  kings  and  emperors — ^tried  to  die  in  the  odor  of 
sanctity  by  donning  a  monk's  cowl,  it  is  easily  understood 
why  the  artist  should  follow  the  general  custom  and  try 
to  make  amends  for  his  real  or  imaginary  sins.  Even 
hardened  scientists  like  Lombroso  feel  this  impulse  to  set 
themselves  right  with  God  in  their  old  age,  and  that  in 
a  much  less  religious  era  like  the  twentieth  century.  The 
only  difference  is  in  the  method.  Michelangelo  followed 
tiie  approved  method  of  his  age  by  giving  money  to  the 
church  for  masses  and  alms  to  the  poor ;  Lombroso  died 
the  defender  and  believer  in  a  spiritism  which  he  knew 
to  be  tinctured  with  fraud,  and  the  champion  of  a 
*'  medium  "  who  had  been  exposed  several  times.  That 
was  not  even  the  approved  method  of  our  age. 

The  Bach  family  thrived  for  three  centuries,  com- 
mencing in  1550  and  producing  29  musicians  of  emi- 
nence. Sebastian  Bach,  the  greatest  of  the  family,  be- 
came blind  shortly  before  his  death  at  sixty-five,  after 
such  severe  use  of  his  eyes  as  perhaps  few  have  ever 
endured.  He  was  a  man  of  tireless  industry  and  great 
vitality,  and  the  general  respect  in  which  he  was  held  as 
an  excellent  father,  friend  and  good  citizen,  proves  that 
his  contemporaries  found  him  perfectly  normal. 

Of  Beethoven — the  least  promising  from  a  physical 
point  of  view  in  this  series  of  ten  geniuses — we  have  a 
special  study  by  Dr.  James  Frederick  Rogers."®  Bom 
of  a  consumptive  mother  and  a  sottish  father,  much 
abused  in  his  childhood  by  having  to  practice  for  whole 
nights,  he  was  nevertheless  a  physically  strong  man,  and 
had  a  powerful  constitution.  Dr.  Rogers  says :  "  The 
physical  Beethoven  was  a  most  impressive  figure.  He 
was  not  tall — was  in  fact,  short — not  over  five  feet  five 
inches,  but  with  broad  shoulders,  and  very  firmly  built. 


HEALTH  AND  ORIGINALITY 


255 


Siegfried  said  that  'in  that  limited  space  was  concen- 
trated the  pluck  of  twenty  battalions.'— On  the  whole 
his  was  not  a  handsome  figure,  'but  the  ugly  pock- 
marked man  with  the  piercing  eye  was  possessed  of  a 
power  and  beauty  more  attractive  than  mere  physical 
charm.'  One  person  described  him  as  '  power  personi- 
fied,' and  another  thought  of  him  as  Jupiter."  Toward 
the  end  of  his  article  Dr.  Rogers  says :  "  Beethoven  re- 
mained physically  robust  to  the  last,  notwithstanding  his 
continual  fight  with  disease.  ...  The  examination  of 
the  wreck  of  that  most  powerful  bodily  machine  showed 
the  auditory  nerves  shriveled  and  degenerated,  the  liver, 
the  source  of  his  digestive  disturbances,  shrunken  to  half 
its  normal  size,  and  there  were  other  signs  of  chronic 
disease.  .  .  .  The  convolutions  of  the  brain  were  more 
numerous  and  twice  as  deep  as  usual."  He  died  at  fifty- 
seven. 

In  another  article  Dr.  Rogers  discusses  the  relation  of 
the  intellectual  and  the  physical  life.  After  examining 
about  ninety  men  of  genius  and  talent  in  various  walks 
of  life,  he  says :  "  Of  those  mentioned,  some  seventeen 
may  be  said  to  have  been  more  or  less  delicate  from  child- 
hood, though  most  of  these  were  by  no  means  sickly 
much  of  the  time.  Some  eight  or  ten  more,  like  Darwin 
and  Spencer,  broke  down  after  a  healthy,  vigorous  youth 
and  early  manhood.  At  least  fifty  were  robust  and  many 
of  these  remarkable  for  physical  powers.  The  remainder 
were  probably  above  the  average  in  physical  endurance, 
even  if  their  physique  and  health  was  not  so  impres- 
sive." *•• 

The  temptation  is  very  strong  to  take  up  at  least  briefly 
the  many  men  of  our  own  generation  who  have  attained  to 
prominence  in  various  fields  of  life,  and  to  show  that  with 
increasing  knowledge  concerning  the  importance  of  health 


256       HEALTH  AND  SOCIAL  PROGRESS 

for  maintaining  a  sound  mentality,  the  health  of  geniuses 
and  talented  men  has  generally  been  at  least  good,  and 
in  most  cases  excellent.  The  prominent  men  at  German, 
French,  English,  and  American  universities  are  usually 
healthy,  if  not  robust.  We  must,  however,  proceed  to  the 
second  part  of  this  chapter  to  discuss  briefly  what  is 
meant  by  originality. 

Genius  was  regarded  as  a  useful  variation.  Origi- 
nality then  must  mean  useful  innovation.  A  man  cannot 
be  regarded  as  a  genius  merely  because  he  originates  new 
ideas.  Extraordinary  power  of  synthesis  may  be  of  two 
kinds,  socially  useful  or  useless.  The  true  genius  is 
generally  in  close  touch  with  his  times;  is  keenly  in- 
terested in  the  highest  endeavors  of  his  contemporaries, 
and  tries  to  direct  them  not  only  into  new,  but  into 
socially  useful  channels  by  virtue  of  his  wider  outlook 
and  deeper  insight.  The  genius  is,  consequently,  the 
average  man  raised  to  the  highest  power;  and  this  en- 
ables him  to  be  more  useful  in  directing  the  currents  of 
his  time  than  are  the  majority  of  men.  "  To  know  that 
the  greatest  men  of  earth  are  men  who  think  as  I  do,  but 
deeper,  and  see  the  real  as  I  do,  but  clearer,  who  walk  to 
the  goal  that  I  do,  but  better, — ^that  may  be  an  incitement 
to  my  humility,  but  it  is  also  an  inspiration  to  my  life."  *** 
Unless  the  genius  contributes  in  some  substantial  manner 
to  the  welfare  of  his  fellowmen,  he  may  have  a  temporary 
vogue  but  no  enduring  fame.  Mere  originality  in  the 
sense  of  producing  something  new  that  has  no  relation  to 
the  well-being  of  man,  may  be  indicative  of  great  power 
of  imagination,  but  it  can  startle  only  savages  and  bar- 
barians. There  is  more  originality  of  this  kind  to  be 
found  in  the  Sacred  Books  of  the  East  or  in  the 
Kwakiutle  Tales  of  one  tribe  of  the  Columbian  Indians, 
than  can  be  discovered  in  our  most  resourceful  poets. 


HEALTH  AND  ORIGINALITY 


257 


This  originality  had,  however,  very  little,  if  any,  con- 
nection with  life,  and  left  the  people  at  the  social  level 
where  the  men  highly  gifted  with  imagination  found  it. 
Men  of  this  kind  may  make  many  people  rich  with 
conjectural  benefits,  but  the  hollowness  of  their  promises 
will  soon  be  discovered.  The  medicine  man  and  the 
shaman  of  various  religions  among  barbarians,  were  com- 
pelled sooner  or  later  to  yield  the  first  place  to  the  war- 
rior who  actually  liberated  his  people  from  the  enemy 
or  protected  them  against  him.  With  these  tangible  bene- 
fits the  medicine  man  could  not  compete ;  and  in  order  to 
maintain  his  influence,  he  often  resorted  to  fraud  by  go- 
ing into  a  trance,  claiming  inspiration  from  his  deity,  or  in 
some  other  way.  The  magician  of  the  Middle  Ages  was 
in  a  similar  position;  he  often  claimed  power  which  he 
could  not  prove  to  be  real,  and  so  was  not  altogether  un- 
justly incarcerated  or  put  to  death. 

What  impresses  people  in  the  long  run  is  the  demon- 
strable and  the  true.  This  has  been  the  only  salvation  of 
science  in  its  long  contention  against  ecclesiasticism — it 
could  prove  its  statements  by  conferring  substantial  bene- 
fits upon  society.  Of  the  other  type  of  men — rich  in 
power  of  unbridled  imagination — ^the  vast  majority  have 
been  at  least  slightly  insane  or  degenerate.  And  it  is 
mostly  this  class  which  Lombroso  discusses ;  but  he  shotdd 
not  have  honored  these  men  with  the  name  of  genius. 

True  genius  is  sane,  because  it  is  generally  healthy. 
There  are  three  tests  of  sanity  for  the  genius — objectivity, 
attainability,  utility. 

The  genius  produces  something  of  which  society  may 
avail  itself.  Whether  as  poet,  artist,  philosopher,  states- 
man, or  scientist,  he  gives  something  to  his  fellowmen 
which  they  recognize  as  theirs,  and  adopt.  A  poem  may 
be  clothed  in  the  most  beautiful  language,  but  will  not  be 


i\ 


■i 


258      HEALTH  AND  SOCIAL  PROGRESS 

read  if  it  does  not  somehow  or  other  find  an  echo  in  the 
minds  of  the  many.  The  experience  expressed  must  be 
capable  of  being  experienced  by  the  average  man  when 
he  reads  it ;  he  must  be  able  to  say  to  himself,  "  this  man 
expressed  what  I  felt  but  could  not  state  in  words."  A 
poem  setting  forth  an  unique  experience  which  has  no 
racial  or  national  background  is  generally  only  an  adorn- 
ment on  the  shelves  of  libraries  or  is  consigned  to  the 
waste-basket,  because  it  is  not  in  touch  with  the  current 
of  life — the  poet  has  failed  to  make  his  experience  ob- 
jective, i.e.,  experiential  by  other  men.  The  artist  who 
appeals  to  the  nation  or  to  the  race,  has  something  in  his 
picture  or  his  statue,  which  stirs  their  imagination  as 
something  they  have  in  common  with  him;  and  he  will 
succeed  in  proportion  as  he  is  firmly  rooted  in  the  spirit 
of  his  age.  Hence  the  greatest  art  has  always  been  na- 
tional in  character — Greek,  Roman,  and  Medieval.  The 
great  artists  of  every  age  express  the  tendencies  of  the 
times  in  a  higher  key  than  other  men  can  do;  but  the 
contact  with  others  is  always  there,  and  close.  The  phi- 
losopher likewise  expresses  the  best  thoughts  of  his  con- 
temporaries in  the  most  logical  and  systematic  manner. 
They  understand  him,  because  he  is  flesh  of  their  flesh 
raised  to  a  higher  power.  Hence  the  changing  periods 
in  art,  poetry,  and  philosophy.  Only  the  men  of  highest 
genius  have  succeeded  in  impressing  themselves  not  only 
upon  their  contemporaries  but  upon  posterity,  because 
they  treated  subjects  which  concern  all  men  in  a  masterly 
manner.  The  genius  rose  in  this  case  from  individual 
experience,  thence  through  national  to  general  human  ex- 
perience. 

The  scientist  is,  however,  the  most  objective  of  all 
great  men.  He  creates  something  which  other  men  can- 
not only  feel  after  him,  but  do  after  him.     The  artists 


HEALTH  AND  ORIGINALITY 


259 


of  Athens  and  of  Florence  are  still  in  many  cases  un- 
excelled, because  their  originality  was  only  in  part  ob- 
jective. They  succeeded  in  making  others  feel  what  they 
alone  could  express;  but  they  could  not  teach  their 
method;  that  was  largely  subjective.  Others  might  see, 
admire,  receive  instruction,  but  could  not  produce  more 
than  replicas  of  the  masterpieces.  For  art  is  subjective 
and  a  man  must  create  his  own  method,  and  that  is  not 
communicable.  If  this  statement  were  not  true,  we 
would  excel  the  Greeks  in  art  at  least  as  much  as  we  do 
in  science.  But  we  are  still  their  unsuccessful  imitators, 
notwithstanding  the  vast  progress  in  the  purely  mechani- 
cal means  which  science  has  furnished  the  artist.  The 
problem  of  art  is,  consequently,  still  unsolved  and  rests 
on  that  of  individuality. 

Philosophy  is  more  objective  than  art,  because  its 
reasoning  can  be  followed,  repeated,  and  improved  by 
others.  But  it  deals  largely  with  ultimate  problems,  and 
hence  rarely  succeeds  in  solving  any  of  them.  The  ques- 
tions which  confronted  Plato,  the  Stoics,  Kant,  and  Hegel 
are  still  awaiting  a  final  answer.  The  same  problems  are 
discussed  today  as  of  yore;  we  simply  have  more  phi- 
losophies than  before. 

It  may  be  said  that  neither  has  science  reached  any 
definite  agreement  in  regard  to  many  points,  as  proved 
by  the  constant  change  in  its  hypotheses.  That  is  true. 
There  is,  however,  this  diflFerence.  When  a  scientist  in 
Berlin  reaches  a  conclusion,  it  can  definitely  be  proved 
to  be  true  or  false,  because  the  method  by  which  the 
results  were  obtained  is  objective  and  the  experiment  can 
be  repeated  in  London,  Paris,  New  York,  Chicago,  Tokio, 
or  Melbourne,  and  must  yield  the  same  results  if  the 
method  is  correct.  If  verification  is  impossible,  the  con- 
clusion or  the  method  stands  condemned;  if  the  same 


260       HEALTH  AND  SOCIAL  PROGRESS 

results  are  obtained,  it  is  generally  accepted  and  forms 
a  permanent  addition  to  knowledge,  serving  as  a  new 
basis  from  which  other  departures  may  be  taken  for 
further  experiments.  Again,  differences  among  scien- 
tists occur  chiefly  in  the  realm  of  philosophy^  i.e.,  in  the 
interpretation  and  ultimate  meaning  of  facts.  No  one 
doubts,  for  instance,  the  phenomenal  benefits  derived 
from  electricity.  What  electricity  is,  concerns  not  science 
so  much  as  it  does  philosophy,  because  that  problem  is 
connected  with  the  ultimate  constitution  of  matter.  The 
use  of  scientific  imagination  may  eventually  give  an 
answer  to  that  question,  but  meanwhile  science  proceeds 
from  one  conquest  of  nature  to  another  by  means  of 
experiments,  and  puts  an  ever  larger  number  of  men 
into  a  position  to  do  and  repeat  what  scientists  do. 
Science  has  made  it  possible  to  distribute  the  works  of  art 
and  poetry  more  widely  than  ever,  without  producing  any 
great  men  in  these  activities,  although  it  has  helped  to 
increase  the  number  of  men  attaining  high  rank  in  various 
scientific  fields  very  considerably.  Full  objectivity  re- 
quires sanity;  i.e.,  balance  of  mind,  ability  to  compare 
and  to  judge  accurately,  and  self-control,  so  as  not  to  be 
led  away  by  whims  and  impulses.  All  this  is  possible 
only  on  the  basis  of  good  health. 

A  remark  may  be  in  place  here.  The  reason  why  the 
geniuses  of  the  more  subjective  type  were  held  in  such 
high  honor  during  the  past  seems  to  be  the  inability  of 
the  many  to  repeat  what  the  great  man  did.  When  the 
shaman  throws  himself  into  a  trance,  few  are  able  to  re- 
peat the  feat.  This  principle  applies  in  a  decreasing  ratio 
to  the  poet,  artist,  and  philosopher.  On  the  other  hand 
the  scientist  is  more  honored  today,  because  we  have 
emerged  from  the  more  emotional  and  subjective  attitude 
to  the  intellectual  and  objective;  i.e.,  we  have  gained  a 


HEALTH  AND  ORIGINALITY 


261 


truer  idea  of  the  genius  as  a  higher  power  of  ourselves. 
He  is  no  longer  an  enigma  to  us  because  we  know  that, 
being  firmly  rooted  in  social  experiences,  he  drinks  from 
the  same  fountain  of  knowledge  as  we  do,  but  more 
deeply. 

Attainability  is  the  second  mark  of  sanity  in  genius. 
"  The  Kingdom  of  heaven  (still)  suffereth  violence,  and 
the  violent  take  it  by  force.'*  The  kingdom  of  man  is  in 
the  same  position  at  the  hands  of  the  youthful  genius  who 
is  full  of  violence  and  wants  to  bring  about  the  millen- 
nium not  only  in  impossible  ways  but  in  a  wild  rush. 
Very  nearly  every  youthful  genius  has  started  out  to 
declare  war  against  society  and  to  devise  plans  which 
were  plainly  unattainable.  From  Schiller  and  Shelley, 
down  to  Stimer  and  Nietzsche  there  is  one  continual 
variant  of  the  same  subject — society  must  be  reformed 
rapidly  and  completely.  The  ways  and  means  proposed 
betray  an  utter  lack  of  insight  into  the  slow  and  gradual 
development  of  intelligence  and  power  of  coordina- 
tion among  men.  The  relation  between  means  and 
ends  is  incomprehensible  to  this  type  of  immature  in- 
tellect. 

"  The  Solarian  citizens  have  made  wonderful  progress 
in  the  arts  and  sciences.  They  have  ships  that  plow 
the  seas  without  sails  and  without  oars;  and  cars  that 
arc  propelled  by  the  force  of  the  wind;  they  have  dis- 
covered how  to  fly,  and  they  are  inventing  instruments 
which  will  reveal  new  stars.  They  know  that  the  world 
is  a  great  animal  in  whose  body  we  live,  and  that  the 
sea  is  produced  by  the  sweat  of  the  earth,  and  that  all 
the  stars  move.  They  practice  perpetual  adoration,  offer 
up  bloodless  sacrifices,  and  reverence  but  do  not  worship 
the  sun  and  the  stars."  *"  One  may  argue  that  a  number 
of  things  prophesied  by  Campanella  in  this  passage  have 


i 


i' 


262       HEALTH  AND  SOCIAL  PROGRESS 

come  true  and  he  deserves  the  epithet  of  "  sane  " ;  but 
the  fact  that  the  possible  is  juxtaposed  with  the  absurd 
and  that  absolutely  no  means  are  indicated  how  to  attain 
the  possible,  is  sufficient  indication  of  insanity ;  and  there 
is  no  need  to  refer  to  Campanella's  badly  formed  skull 
with  its  seven  hills  or  inequalities,  to  find  it  out.  No 
inventor  or  discoverer  working  in  the  realms  of  steam, 
aeronautics,  or  telescopy  could  even  get  a  hint  of  how 
to  proceed  from  reading  all  the  books  on  Utopia  ever 
written.  They  plainly  deal  with  the  unattainable,  be- 
cause they  have  no  basis  in  the  facts  then  known;  and 
when  the  author  of  "  The  City  of  the  Sun  "  claims  that 
the  citizens  of  that  commonwealth  will  be  invincible  in 
battle  because  they  fight  for  their  country,  natural  law, 
justice,  and  religion—he  speaks  of  something  for  which 
no  basis  will  ever  be  known. 

The  sane  genius  always  strives  for  the  attainable,  since 
he,  better  than  anyone  else,  knows  both  the  capacities  and 
limitations  of  human  nature.  It  may  take  a  long  time 
and  infinite  pains — and  from  this  point  of  view  Michel- 
angelo's definition  of  genius  as  an  infinite  capacity  for 
taking  pains,  is  perfectly  correct— to  attain  to  higher 
levels  of  social  and  individual  living,  but  the  genius  does 
not  swerve  from  the  path  known  to  be  correct  after  a 
careful  examination  of  the  facts  has  disclosed  the  at- 
tainable. Any  other  road  may  hold  great  promises  of 
conjectural  benefits,  but  the  sane  man  knows  them  to  be 
spurious,  because  unattainable,  and  prefers  to  work 
slowly  toward  a  goal  which  will  be  reached  sooner  or 
later.  If  not  able  to  reach  it  during  his  own  lifetime,  he 
is  satisfied  to  open  the  path  for  future  generations; 
but  he  will  not  make  promises  which  are  untrue  to  the 
facts.  The  long  and  wearisome  search  of  Darwin 
through  almost  innumerable  details  before  reaching  one 


HEALTH  AND  ORIGINALITY  263 

conclusion  is  a  good  illustration  of  the  respect  for  facts 
which  the  true  genius  has.  Every  objective  genius  has 
worked  in  this  manner,  and  that  is  the  reason  why  the 
results  obtained  are  substantial  and  lasting,  as  well  as 
broad  and  universal.  In  the  objective  realm  the  attain- 
able can  be  reached  only  in  conformity  with  the  facts,  and 
the  sane  genius  knows  it  better  than  the  less  gifted,  simply 
because  his  mental  horizon  is  broader  and  his  insight 
deeper. 

The  third  criterion  of  sanity  in  genius  is  utility.    What- 
ever a  great  mind  may  produce  must  ultimately  be  tested 
by  its  applicability  to  society  as  it  is,  even  though  the 
purpose  be  to  raise  men  to  a  higher  level.    Utility  is  not 
to  be  understood  here  in  the  sense  of  market  value,  but 
in  the  sense  of  benefiting  society  either  by  inspiration 
through  higher  ideals  or  by  providing  better  conditions  of 
living.    From  this  point  of  view  there  is  again  a  distinc- 
tion between  the  less  and  the  more  objective  genius.    The 
former  may,  by  the  power  of  rich  and  facile  construc- 
tion, give  us  joy  or  consolation  through  art  and  litera- 
ture ;  and  by  raising  the  tone  of  our  mentality,  he  may 
be  very  useful  to  society.    But  after  all,  art  and  literature 
are  holiday  aflFairs  for  the  great  majority  of  men ;  they 
enable  us  to  enjoy  ourselves  when  we  are  "  oflp  duty  "— 
a  condition  which  to  most  men  is  a  comparatively  rare 
experience.    And  it  cannot  be  otherwise  in  the  very  nature 
of  things.    What  has  come  so  easily  to  one  man  cannot 
aflPect  other  men's  lot  very  deeply.     To  give  joy  and 
pleasure  is  useful;  but  to  increase  the  means  of  life  and 
to  ease  its  burdens  is  more  useful.    And  the  latter  can 
be  done  only  by  the  hard  and  constant  work  of  the  more 
objective  genius.    To  invent  the  steam  engine  or  to  dis- 
cover  the  relation  between  certain  parasites  and  certain 
diseases,  requires  strenuous  application,  frequently  for 


t: 


if 


ii 


V" 


264       HEALTH  AND  SOCIAL  PROGRESS 

long  periods.  But  the  results  justify  the  pains  taken,  be- 
cause they  aflfect  the  whole  of  society  in  its  work-days. 
And  this  is  true  not  only  of  scientific  innovations,  but 
philosophical  as  well.  To  give  the  world  a  well-thought- 
out  system  of  metaphysics,  or  epistemology,  or  psychol- 
ogy ;  and  to  make  men  think  clearly  and  logically,  is  often 
exceedingly  useful  even  though  the  whole  scheme  may 
be  out  of  touch  with  life;  because  our  whole  civilization 
consists  of  ideas  rather  than  of  material  possessions. 
Such  systems  cannot  be  built  up,  however,  by  "  inspira- 
tion," but  only  by  close  application  and  the  ability  to 
sustain  mental  conflict  for  a  long  time.  The  usefulness 
of  the  productions  of  genius  is,  consequently,  always  pro- 
portionate to  the  work  involved. 

This  implies  that  the  ethical  value  of  work  applies  to 
the  genius  as  well  as  to  other  men.     And  here  we  get 
another  distinction  between  the  subjective  and  the  ob- 
jective genius.    It  is  certainly  noteworthy  that  the  men 
of  genius  who  have  gone  wrong  belong  with  rare  ex- 
ceptions to  the  former  type.    Because  production  is  com- 
paratively easy  for  them,  they  feel  less  in  need  of  the 
stem  discipline  which  the  scientific  worker  has  to  impose 
upon  himself.     As  a  matter  of  fact,  the  subjective  is 
always  easier  than  the  objective.    And  if  a  man  deliber- 
ately chooses  the  subjective  he  certainly  follows  a  natural 
instinct  along  the  line  of  least  resistance ;  he  misses,  how- 
ever, a  valuable  opportunity  to  develop  qualities  which 
lie  perhaps  dormant,  but  could  be  developed  and  would 
make  him  a  greater  genius  by  keeping  him  in  closer  con- 
tact with  life.     And  the  usefulness  of  the  genius  from 
this  point  of  view  is  very  great,  since  the  deeds  of  the 
men  on  the  heights  gradually  percolate  through  society 
by  imitation ;  and  any  wrong  example  is  certain  to  work 
mischief   with  thousands.     The  model  lives  of  many 


HEALTH  AND  ORIGINALITY 


265 


scientists  and  philosophers  are  as  large  an  asset  from  this 
point  of  view  as  their  work  is  from  another. 

In  closing  this  brief  discussion  of  genius  and  sanity 
a  few  other  remarks  may  be  made.  The  objective  genius 
requires  a  certain  amount  of  maturity.  It  is  a  striking 
fact  that  many  great  men  have  been  pessimistic  in  their 
youth,  e.g.,  Goethe;  while  as  they  reach  manhood  they 
seem  to  overcome  that  stage  and  become  serene  if  not 
optimistic.  This  change  seems  to  be  due  to  greater  ob- 
jectivity attained  through  life's  experiences.  In  propor- 
tion as  our  contacts  with  life  are  varied  and  numerous, 
we  seem  to  gain  not  only  new  knowledge  but  a  more  satis- 
factory view  of  life.  The  pessimist  imagines  life  to  be 
very  diflFerent  from  what  it  actually  is.  This  purely 
subjective  attitude  can  be  overcome  by  larger  experience. 
A  number  of  men  of  genius  who  did  not  live  beyond  this 
period  of  youthful  pessimism,  have  given  us  lamenta- 
tions and  vituperations  about  society  which  have  been 
charged  to  genius  as  such,  whereas  they  ought  to  have 
been  charged  to  its  youth  and  immaturity.  The  young 
man  is  very  sensitive  since  life  has  not  had  an  oppor- 
tunity to  even  up  things  with  him,  and  judgments  are 
formed  rashly  on  the  basis  of  immediate  impressions. 
The  senses  are,  moreover,  keener  than  later  in  life,  and 
joys  and  sorrows  make  a  deeper  momentary  impression. 
The  result  is  that  the  whole  attitude  becomes  largely 
subjective,  and  the  "  Werther "  type  of  Goethe  is  de- 
veloped. In  proportion  as  life  presents  a  greater  variety 
of  experiences  which  influence  the  young,  there  is  a  better 
opportunity  for  the  balancing  of  joys  and  sorrows,  and 
the  attitude  becomes  more  objective  and,  therefore,  more 
optimistic. 

This  immaturity  of  the  young  genius  may  be  explained 
also  on  the  basis  of  intellectual  development.    The  very 


266       HEALTH  AND  SOCIAL  PROGRESS 

young  are  happy  because  lifers  problems  are  not  realized 
and  so  none  exist  beyond  those  of  immediate  physical 
welfare ;  health  is  a  sufficient  reason  to  insure  happiness 
in  children.  The  youth  begins  to  comprehend  these  prob- 
lems, is  unable  to  solve  them,  becomes  puzzled,  and 
sooner  or  later  turns  pessimist,  especially  if  health  is  not 
exceptionally  good — a  frequent  occurrence  since  young 
men  are  usually  careless  of  the  laws  of  hygiene.  The 
more  mature  man  not  only  sees  the  problems,  but  knows 
how  to  solve  them  on  the  basis  of  past  experiences. 
Hence  his  general  attitude  is  one  of  serenity. 

The  individual  repeats  thus  the  experience  of  the  race. 
The  savage,  still  undeveloped,  has  comparatively  few 
problems,  abandons  himself  to  pleasures,  and  is  happy  as 
long  as  the  vital  functions  are  undisturbed.  The  semi- 
civilized  man,  being  more  developed  mentally,  is  puz- 
zled by  the  complexities  of  life,  and  his  attitude  is  serious 
on  the  whole,  since  he  is  unable  to  find  solutions  for  his 
difficulties.  The  civilized  man  is  aware  of  the  problems 
but  is  serene,  since  the  history  of  the  race  has  taught  him 
that  one  difficulty  after  another  has  been  overcome ;  and 
so  he  is  confident  that  other  problems  will  be  solved  in 

due  time. 

The  subjective  genius,  particularly  in  his  youth,  is 
largely  in  the  position  of  the  semi-civilized.  Just  because 
he  is  able  to  see  further  and  deeper,  the  problems  of  life 
seem  more  numerous  and  complex.  Owing  to  inex- 
perience and  to  frequent  neglect  of  health,  he  lacks  ability 
to  find  a  solution  and  the  buoyancy  of  high  vitality  to 
inspire  him  with  hope.  Hence  the  nimierous  pessimists 
among  men  of  this  class. 

The  objective  genius  is  rarely  pessimistic.  His  very 
vocation  calls  for  discipline  in  every  respect.  He  must 
have  keen  perceptions  and  a  clear  mind  in  order  to  ob- 


HEALTH  AND  ORIGINALITY 


267 


serve  facts  accurately ;  hence  he  usually  takes  good  care 
of  his  health.  He  has  trained  himself,  moreover,  to  take 
one  step  at  a  time,  knowing  that  this  will  bring  him  so 
much  nearer  to  a  solution.  Success,  often  moderate 
enough,  inspires  him  nevertheless  with  confidence  that 
complete  success  will  ultimately  be  attained,  and  so  he 
rarely  gives  way  to  useless  complaints  and  lamentations 
— unless  he  is  old  and  decrepit,  a  condition  characterized 
by  inability  to  accomplish,  begetting  a  disbelief  in  the 
performance  of  others.  The  generally  optimistic  atti- 
tude of  scientists  and  of  the  more  mature  philosophers 
is  due  to  the  fact  that  they  have  produced  something  on 
the  basis  of  experience  and  made  it  available  to  others, 
that  they  have  striven  after  the  attainable  and  made  it 
socially  useful.  Men  must  progress  together.  The  genius 
who  is  unintelligible  to  his  fellowmen,  might  as  well  not 
have  lived;  only  in  proportion  as  he  helps  his  fellowmen 
to  see  more  clearly,  to  act  more  generously  and  efficiently, 
and  to  strive  more  nobly  and  earnestly,  can  the  genius  be 
called  sane.    And  to  be  sane,  he  must  be  healthy. 

Whether  genius  is  subjective  or  objective,  the  ex- 
traordinary power  for  synthesis  requires  vitality,  at  least 
if  the  synthesis  is  to  be  coherent  and  applicable  to  life. 
While  this  extraordinary  power  is  characteristic  of  the 
genius,  it  is  not  always  combined  with  facility  of  syn- 
thesis. Even  in  the  case  of  the  subjective  genius  great 
endurance  is  necessary.  Newton  and  Kant  could  main- 
tain for  hours  at  a  stretch  a  struggle  with  difficulties 
which  would  exhaust  an  ordinary  man  in  five  minutes. 
They  did  this,  moreover,  day  after  day,  and  included  a 
vast  mass  of  ideas  in  their  systems.  This  certainly  re- 
quired vitality  of  a  high  order.  We  have  seen  above 
that  Bach  and  Beethoven  had  great  vitality,  although 
musical  genius  is  supposed  to  compose  in  a  flash  or  by 


268       HEALTH  AND  SOCIAL  PROGRESS 


inspiration.  That  may  be  true.  But  long  hours  of  high 
tension  precede  the  fruitful  flash  of  creation,  and  when 
at  last  the  tension  is  released,  the  new  symphony  springs 
fully  planned  into  existence.  Hence  the  exhaustion  which 
usually  follows  one  of  those  creative  moments ;  hence  also 
the  frequent  abandonment  to  sensuous  pleasures  on  the 
part  of  the  weaker  members  of  the  artistic,  musical,  and 
literary  fraternities  after  such  moments.  The  fact  that 
the  highest  men  of  these  classes  were  able  to  keep  their 
equilibrium  at  such  times,  is  an  argument  in  favor  of 
their  health,  while  the  abandonment  of  the  lesser  men 
argues  equally  for  their  lower  vitality.  For,  every  new 
creation  implies  a  heavy  expenditure  of  vitality ;  and  the 
extreme  fatigue  which  overcomes  the  weaker  men,  lowers 
— as  fatigue  always  does — their  power  of  resistance  and 
they  fall  into  evil  ways. 

Richard  Wagner — the  best  timibler  and  sommersault- 
turner  of  the  large  Dresden  school  and  an  adept  at  every 
form  of  bodily  exercise,  who  could  stand  on  his  head 
when  near  seventy  years  of  age  ^** — worked  almost  in- 
cessantly for  a  whole  month  on  his  Walkiire,  although  he 
composed  with  facility.  The  mere  notation  of  the  music 
involved  vast  labor.  Several  of  his  operas  have  each  over 
a  million  notes.  Since  the  stems  are  at  an  axis  of  90 
degrees  and  the  five  ruled  lines  of  the  music  paper  at  an 
axis  of  180  degrees,  and  since  the  value  of  the  notes  is 
almost  constantly  changing,  the  mere  problem  of  writing 
them  down  accurately  required  not  only  much  strength 
but  very  close  application.  Wagner,  moreover,  wrote  the 
libretto  and  designed  the  costumes  as  well  as  the  decora- 
tions for  his  operas.  And  all  this  he  had  to  do  with  astig- 
matic eyes.  Considering  that  he  wrote  twelve  operas 
beside  many  smaller  works,  the  conclusion  that  only  a 
man  of  great  vitality  could  stand  the  strain  is  inevitable. 


HEALTH  AND  ORIGINALITY 


269 


With  the  objective  genius  the  tension  at  any  one  time  is, 
perhaps,  not  so  high ;  but  it  lasts  longer,  often  for  years, 
and  demands  the  combination  of  innumerable  details  in 
many  cases.  The  work  of  great  physicists,  chemists, 
naturalists,  and  physicians  requires  first  of  all  the  mastery 
of  many  facts,  and  then  a  continued  application  for  classi- 
fication, finally  a  high  power  of  coordination,  and  the 
scientific  use  of  the  imagination  if  anything  new  is  to 
be  produced.  This  has  to  be  tested  and  tried  to  see  if  it 
works  properly  and  is  useful.  Much  greater  accuracy  is 
required  in  such  a  case,  since  the  innovation  must  stand 
the  tests  of  other  scientists  and  that  of  saving  or  helping 
human  beings;  e.g.,  a  new  medicine  or  a  new  electrical 
device.  The  scientist  needs,  consequently,  an  imagina- 
tion of  as  high  an  order  as  the  poet  and  artist,  but  it  has 
to  be  better  trained  and  must  include  details.  If  a  piece 
of  art  is  not  acceptable,  that  ends  the  matter;  but  if  a 
bridge  is  poorly  constructed,  hundreds  of  people  may  lose 
their  lives.  Whether  the  genius  be  subjective  or  objective, 
the  exertion  in  creating  something  new  always  involves  a 
tremendous  strain  which  only  men  with  good  vitality  are 
able  to  endure. 

The  majority  of  socially  useful  great  men  have  been 
strong  and  healthy.  They  were  neither  insane  nor  de- 
generates. A  number  of  them  suffered  severely  from 
some  functional  defect,  but  in  every  case  there  was  at 
least  sound  structure,  promising  good  health  with  proper 
care.  Social  conventions  often  required  indulgence  in 
various  vices,  and  the  tremendous  strain  of  creative  ef- 
fort led  many  of  the  subjective  geniuses  to  seek  relief 
along  the  same  channel.  Medical  ignorance  of  former 
times  was  unable  to  cope  with  small  difficulties  and  the 
victims  of  slight  diseases  became  sufferers  from  their 
accumulated  effects.    All  this  has  changed. 


270       HEALTH  AND  SOCIAL  PROGRESS 

The  genius  is  no  longer  required  to  be  a  social  out- 
cast, nor  is  he  expected  to  disregard  the  laws  of  hygiene. 
Physicians  are  able  now  to  relieve  if  not  cure  smaller 
ailments  and  to  render  every  possible  help  to  the  genius 
as  well  as  to  the  ignorant.  Above  all  else,  our  men  of 
science  have  come  to  recognize  the  value  of  health  and  arc 
taking  good  care  of  their  bodies;  consequently  they  are 
as  a  rule  not  only  long-lived  but  vigorous.  Poets  and 
artists  are  gradually  following  in  their  footsteps  in  this 
regard.  The  general  campaign  against  neglect  or  abuse 
of  the  body  is  slowly  affecting  all  classes,  more  particu- 
larly the  mental  workers.  This  may  produce  a  new  con- 
ception of  the  genius  as  the  physically  best-equipped  man 
instead  of  that  of  a  degenerate  or  insane  person.  For, 
the  genius  who  suffered  did  not  produce  because  of  suf- 
fering, but  in  spite  of  it,  by  virtue  of  his  strong  vitality 
and  finely  organized  brain.  His  works  would  have  been 
more  perfect  and  wonderful  had  he  enjoyed  uniformly 
good  health.  If  we  look  at  the  great  masterpieces  of  art, 
literature,  philosophy,  and  science,  produced  by  the  hand- 
ful of  ancient  Athenians,  we  cannot  escape  the  conclusion 
that  the  believers  in  the  principle  of  "  a  sound  mind  in  a 
sound  body"  must  have  been  right.  Ultimately  the 
physically  most  perfect  man  must  have  the  best  mind.  He 
must  be  as  he  has  always  been,  closely  bound  to  the 
thoughts  of  his  contemporaries,  and  incarnate  the  best 
ideas  of  his  times. 

"  He  does  not  create ;  he  reassembles  in  one  organism 
the  scattered  members,  the  medial  vibrations  of  the 
crowd ;  he  feels  and  expresses  all  that  is  new  and  beauti- 
ful and  great  that  is  in  process  of  formation  in  the  men 
who  surround  him,  who  are  frequently  unconscious  of  the 
beauty  which  is  in  them.  .  .  .  The  medial  intellectual  man 
who  has  produced  it  [a  work  of  art  or  of  science]  is  a 


HEALTH  AND  ORIGINALITY 


271 


I 


beneficent  genius  to  humanity  because  he  aids  its  upward 
progress  by  appealing  to  the  better  part  in  each  indi- 
vidual." »*• 

Lombroso  must  have  thought  of  this  combination  of  a 
sound  physique  with  a  sound  mind  when  he  wrote  of  the 
sane  men  of  genius  as  follows : 

"  Such  have  been  Galileo,  Leonardo  da  Vinci,  Voltaire, 
Machiavelli,  Michelangelo,  Darwin.  Each  one  of  these 
showed,  by  the  ample  volume  and  at  the  same  time  the 
symmetrical  proportion  of  the  skull,  force  of  intellect 
restrained  by  the  calm  of  the  desires.  Not  one  of  them 
allowed  his  great  passion  for  truth  and  beauty  to  stifle 
the  love  of  family  and  country.  They  never  changed  their 
faith  or  character,  never  swerved  from  their  aim,  never 
left  their  work  half  cempleted.  What  assurance,  what 
faith,  what  ability  they  showed  in  their  undertakings; 
and,  above  all,  what  moderation  and  unity  of  character 
they  preserved  in  their  lives!  Though  they,  too,  had 
to  experience — after  undergoing  the  sublime  paroxysm 
of  inspiration — the  torture  inflicted  by  ignorant  hatred, 
and  the  discomfort  of  uncertainty  and  exhaustion;  they 
never,  on  that  account,  deviated  from  the  straight  road. 
They  carried  out  to  the  end  the  one  cherished  idea  which 
formed  the  aim  and  purpose  of  their  lives,  calm  and 
serene,  never  complaining  of  obstacles,  and  falling  into 
but  few  mistakes— mistakes  which,  in  lesser  men,  might 
even  have  passed  for  discoveries."*** 


CHAPTER  XIV 
RESULTS  AND  PROSPECTS 

In  the  preceding  chapters,  emphasis  has  been  placed  upon 
the  importance  of  health  from  every  point  of  view,  and 
especially  upon  the  influence  of  malaria  and  hookworm  on 
civilization.  Figures  have  been  given  to  substantiate  the 
statements  which  were  made.  The  reduction  of  malaria 
in  partictilar  was,  however,  due  chiefly  to  the  govern- 
ments which  took  up  sanitation  in  the  tropics  because  they 
had  to  protect  their  own  officials  sent  to  the  infested 
regions.  They  needed  not  to  trouble  themselves  about 
expense,  since  they  had  the  power  of  taxation  and,  in 
many  cases,  that  of  military  discipline.  The  areas  thus 
taken  up  would  always  remain  small  if  private  capital 
could  not  be  interested.  If  disease  is  to  be  eliminated, 
or  at  least  much  reduced,  its  removal  must  be  shown  to 
be  a  profitable  investment  and  proof  must  be  given  that 
the  appeal  is  made  not  merely  to  benevolence  but  to 
sound  business  sense.  It  is  the  purpose  of  this  chapter  to 
give  additional  data  in  proof  of  the  proposition  that  both 
governments  and  private  capital  are  becoming  aware  of 
the  tremendous  opportunities  for  profitable  investment  in 
health,  especially  in  torrid  regions  and  farther  north 
where  endemic  diseases  prevail.  A  forecast  of  what  is 
already  planned  for  the  future  by  one  private  corporation 
will  also  be  necessary  to  show  that  the  problem  of  health 
is  interesting  an  ever  widening  circle  of  intelligent 
people, 

373 


RESULTS  AND  PROSPECTS 


273 


THE  UNITED  FRUIT  COMPANY 

The  United  Fruit  Company  was  organized  in  1899. 
Recognizing  the  necessity  of  health  among  its  workers, 
the  company  organized  a  sanitary  and  medical  department 
in  1900.  It  is  the  business  of  this  department  to  lay  out 
settlements  for  the  workers,  keep  them  in  sanitary  con- 
dition, and  instruct  the  laborers  and  their  families  in 
dietetics  and  hygiene.  The  plantations  are  kept  free  as 
far  as  possible  from  mosquitos  and  other  insects.  Hos- 
pitals are  provided  in  the  different  republics,  clinics  in 
the  larger  settlements,  and  physicians  in  the  smaller 
ones.  In  order  to  encourage  the  study  of  diseases 
which  are  most  frequent  in  the  territories  where 
the  company's  lands  are  located,  it  started  and  sup- 
ported a  school  of  tropical  medicine  at  Tulane  Uni- 
versity, La. 

The  Company  had  invested  $220,244  in  hospitals  dur- 
ing 1912,  and  $451,391  in  1913.  From  the  annual  reports 
of  the  medical  department  the  following  interesting 
figures  are  taken.  The  author  wishes  to  acknowledge 
the  kindness  of  Dr.  W.  £.  Decks  for  his  valuable  as- 
sistance in  this  part  of  the  discussion. 


Year  Hospitals 

1912  10,383 

1913  10,497 

1914  15,406 

1915  12,362 


Death 

Rate  in 

Toro 

(Panama) 

Bocas 

ispensanes 

White 

Black 

Total 

53,082 

12 

11.15 

1 1.2 

61,932 

3.33 

77 

7.5 

91324 
83,117 

0 
0 

'U 

Y^ 

\ 


A  striking  feature  is  the  low  hospital  mortality  rate: 
30  per  1,000  in  1912;  33  in  1913;  26  in  1914,  and  41  in 
1915.    Another  striking  feature  is  the  low  morbidity  rate 


II 


274       HEALTH  AND  SOCIAL  PROGRESS 

in  Eocas  del  Toro;  it  was  lowest  in  February.  1912,  with 
18.36  per  1,000  and  highest  in  August  with  28.52.  This 
compares  well  with  an  average  of  33  per  1,000  in  the 
United  States,  even  though  all  ages  of  the  population  are 
included  in  this  figure,  while  for  Bocas  del  Toro  we  have 
only  the  workingmen  of  the  company. 

The  education  of  the  laborer  has  been  one  of  the  princi- 
pal objects  of  the  company.     The  worker  knows  now 
that  It  is  to  his  interest  to  obey  the  rules  of  the  physicians  ; 
he  has  learned  that  the  protection  of  his  health  against 
mosquitos  is  an  important  matter,  and  needs  but  little 
urging  to  help  to  wipe  out  the  pest.     In  pursuit  of  its 
educational  campaign  the  company  has  provided  schools 
and  churches,  which  have  helped  to  produce  a  better  class 
of  labor,  since  both  teachers  and  ministers  preach  sanita- 
tion.  With  a  steady  and  well  paid  job,  a  house  and  a 
garden,  chickens  and  other  fowl,  the  laborers  are  happy 
and  contented.    They  have  varied  in  number  from  about 
20,000  with  dependents  in  1904,  to  71,910  in  1914,  but 
they  have  always  willingly  paid  the  small  monthly  contri- 
bution to  meet  the  considerable  annual  deficit.    Accord- 
mg  to  a  letter  of  September  18,  1916,  from  Dr.  W.  E. 
Deeks,  the  general  superintendent  of  the  medical  de- 
partment, the  relation  of  the  deficit  of  this  department 
to  the  "operating  cost  of  tropical  divisions"  was  as 
follows : 


Defict  of  Medical 
7nVf  ♦X°**L^2^  Department         PcrcentMe 

l^li 19,676,607.84  130.047.16  0^6 

*^'5 16,647,077.19  134,804.73  <x8i 

The  reason  for  the  increase  of  the  deficit  was  the  fact 
that  fewer  laborers  were  employed  in  1914  and  1915, 


RESULTS  AND  PROSPECTS 


275 


f 


while  the  overhead  charges  of  the  medical  department 
remained  the  same.  These  statistics  prove  that  san- 
itation in  the  tropics  is  not  ruinous  for  private  enter- 
prise. 

The  men  at  the  head  of  this  company  had  a  large 
vision.  They  were  willing  to  meet  disappointments  and 
temporary  loss  in  several  branches  of  the  business.  Per- 
haps the  most  difficult  task  was  the(  education  of  the 
laborers,  since  no  military  discipline  could  be  resorted 
to,  nor  importation  of  Spaniards  and  Italians.  The 
company  made  it  an  object  to  get  its  working  material 
on  the  spot  by  educating  the  natives  and  negroes.  This 
required  the  arousing  of  interest  on  the  part  of  an 
apathetic  class  of  people.  It  was  done  by  improving  the 
health  of  the  workers  through  sanitation  and  hygiene, 
because  an  under- vitalized  man  is  content  with  few  things 
and  stops  work  when  these  are  obtained ;  while  a  healthy 
man  has  more  wants  and  is  able  and  willing  to  work 
longer  to  secure  them.  The  shiftlessness  and  unrelia- 
bility of  the  laborer  in  the  tropics  is  due  to  poor  vitality, 
and  an  educational  campaign  must  begin  with  the  im- 
provement of  health  and  sanitation. 

The  company  has  found  this  expenditure  good  business. 
Its  assets  in  1900  consisted  chiefly  in  land,  of  which  it 
possessed  or  leased  236,201  acres  in  various  parts  of 
tropical  and  sub-tropical  America;  only  66,294  of  this 
acreage  was  improved.  In  1913  it  controlled  by  lease  or 
deed  1,210,443  acres — ^an  area  almost  equal  to  the  state 
of  Delaware— of  which  331,344  acres  were  improved.  It 
has  established  a  number  of  towns  and  cities,  steamship 
lines  and  railroads  with  terminal  facilities;  it  controls 
a  large  share  of  the  exports  and  imports  of  various 
smaller  states,  and  has  paid  over  ten  per  cent  in  annual 
dividends,  besides  putting  a  large  share  of  the  earnings 


I 

pi 


276      HEALTH  AND  SOCIAL  PROGRESS 

back  into  the  business,  and  accumulating  a  surplus  of 
$16,284,211  by  September,  1913* 

The  occupation  of  the  tropics  may  seem  a  formidable 
undertaking.    So  was  that  of  our  own  continent.    Little 
did  the  5,000,000  people  of  this  country  dream  in  1800 
that  by  1900  we  should  have  occupied  all  the  land  be- 
tween the  Atlantic  and  the  Pacific.    We  increased  our 
farm  area  from  1850  to  1900  by  463.000.000  acres,  an 
average  of  25,000  acres  daily.    The  new  farms  occupied 
and  improved  within  these  fifty  years  are  greater  in 
area  than  Germany,  France,  Italy,  England,  Scotland, 
Denmark,  Belgium,  Ireland,  Holland,  and  Switzerland 
in  the  aggregate.     It  was  the  love  of  adventure  and 
abounding  health  that  made  us  do  it.     Necessity  will 
compel  us  to  do  in  the  tropics  what  we  have  done  at  home. 
In  two  or  three  centuries  the  increased  population  of 
the  world  will  cry  for  bread,  and  the  tropics  will  have  to 
furnish  it— if  the  world  can  wait  that  long.    We  shall 
have  to  do  it,  and  we  already  have  the  means. 

Perhaps  the  principal  foods  for  the  white  race  will 
always  be  produced  in  the  temperate  zones.  But  we 
have  constantly  extended  the  area  of  cereals  further 
north.  In  a  few  decades,  varieties  of  wheat,  rye,  and 
barley  have  been  profitably  produced  by  scientific  selec- 
tion in  Winnipeg  and  further  north.  No  one  supposed 
fifteen  years  ago  that  Alaska  would  produce  a  variety  of 
cereals ;  yet,  in  1914,  the  harvester  was  singing  its  song 
along  the  Yukon  River.  Another  variety  of  wheat  has 
been  produced  which  yields  excellent  crops  on  the 
formerly  arid  lands  of  Colorado,  Idaho,  and  Wyoming. 
Even  the  desert  lands  of  southern  California  and  Arizona 

aI^  TtfSV'^'^i!  ^fJH  ^:?^*«*  by  Frederick  Upham 
^ff"»'  ^«Wc<»*y.  Pafi^  &  Co.,  New  York,  1914,  for  »  com- 
plete deicnption  of  this  company,  ~»    ^  •»» 


I 


RESULTS  AND  PROSPECTS     277 

have  opened  up  their  wonderful  resources  at  the  magic 
touch  of  irrigation. 

With  these  facts  before  us,  it  is  entirely  within  the 
range  of  probability  that  cereals  and  even  cattle  will  be 
adapted  to  lower  latitudes  in  the  course  of  time.    The 
tropics  and  sub-tropics  will  undoubtedly  furnish  a  larger 
amount  of  food  for  the  population  of  the  future.    Scien- 
tific selection  is  a  young  though  lusty  branch  of  knowl- 
edge.    What  it  will  achieve  in  a  century,  no  man  now 
hvmg  can  tell.     We  are  no  longer  subject  to  nature; 
we  have  mastered  her  in  many  ways,  and  our  control  over 
her  forces  is  growing  constantly.     Telic  civilization  has 
taken  the  place  of  genetic  development.    We  know  what 
we  want,  and  adapt  ways  and  means  to  satisfy  our  needs 
The  forces  of  nature  controlled  development  in  the  past  • 
m  the  future  man  will  control  his  own  fate.    Climatical 
and  geographical  features  are  becoming  less  important 
every  day.     Perhaps  General  Gorgas  may  prove  right 
after  all  m  claiming  that  civilization  is  drifting  back  to  the 
tropics.    He  states  *  that  man  could  travel  faster  than  the 
inicrobes,  and  thus  reached  healthy  regions  in  higher 
latitudes  where  he  could  live  and  be  well,  after  the  dis- 
covery of  fire  and  clothing.    Now  he  has  discovered  how 
to  go  back  to  the  tropics  by  controlling  the  diseases  which 
drove  him  out.    The  increase  in  population  will  certainly 
compel  man  to  obtain  more  food  there  by  improving  the 
health  of  those  countries. 

SOUTHERN  UNITED  STATES 

When  the  Rockefeller  Sanitary  Commission  began  its 
work  for  eradicating  hookworm  in  the  Southern  States 
much  opposition  had  to  be  overcome  and  an  educational 

•  Of,  cit,  p.  286  ff, 


278       HEALTH  AND  SOCIAL  PROGRESS 

campaign  had  to  be  carried  on  in  order  to  show  that  the 
work  was  imperatively  necessary  for  the  health  and  wel- 
fare of  the  people.  As  soon  as  the  results  proved  the 
importance  of  the  work  done,  legislatures  became  more 
deeply  interested  and  appropriated  money  more  liberally 
for  the  purpose  of  improving  sanitary  conditions.  The 
appropriations  increased  from  $255,395  in  1910  to 
$1,416,111  in  1918.  This  made  possible  the  treatment 
of  an  ever  larger  number  of  hookworm  and  malaria 
victims,  but  what  is  more  significant  is  the  reduction 
in  the  cost  of  treatment  per  patient.  In  1910,  for 
hookworm  patients,  it  was  $4.66;  in  1911,  $1.05; 
in  1912,  $0.72,  and  has  since  that  time  been  kept 
low. 

A  striking  illustration  of  the  effect  of  practically  rid- 
ding a  community  of  malaria  is  furnished  by  the  report  of 
the  International  Health  Board  for  1918.  The  town  of 
Hamburg,  Arkansas,  has  a  population  of  1,285.  In  1916 
there  were  2,312  physicians'  calls  for  malaria;  in  1917, 
after  the  Board  had  been  working  for  one  year,  there 
were  259 ;  in  1918,  only  59.  The  reduction  from  1916  to 
1918  was  97.4  per  cent.  The  per  capita  cost  was  reduced 
from  $1.45  in  1917  tQ  $0.44  in  1918.  The  demonstra- 
tion of  the  feasibility  and  economic  value  was  so  com- 
plete that  Hamburg  took  over  the  entire  cost  of  the  work 
at  the  end  of  1917,  having  paid  only  33  per  cent  of  the 
expenses  in  1916  after  an  educational  campaign  had  con- 
vinced the  people  of  the  necessity  of  the  work.  At  $2.00 
per  physician's  call  this  community  paid  in  1916  alone 
$4,624 — ^a  sum  several  times  larger  than  it  paid  in  the 
two  following  years  to  get  rid  of  malaria  and  the  mos- 
quito as  a  pest.  This  case  is  only  one  out  of  many  in 
various  parts  of  the  South ;  everywhere  a  comparatively 
small  outlay  made  under  the  direction  of  experts  was 


RESULTS  AND  PROSPECTS     279 

sufficient  to  practically  exterminate  malaria  by  controUiiwr 
the  breeding-places.* 

«;,17'"  """•'""«»"'  f°'  hookworm  disease  made  among  Umted 

S'ror^rLrf ""''  '"  •  '^"""'^  *"'  **  board-,*  expen. 
enceof  the  last  few  years,  and  demonstrated  that  even  »riit 

"Tu^eTh  ""/rr  "c-  °'  '^""  •'"PO't'nce,"  says  Zr^ 
Jh.?  i!  ^'  Bmet-S.mon  and  other  tests,  many  full-™ 
m^u  H,  ?  "^'"^  comparatively  few  hookwo^s  had  X 
menuhty  of  persons  only  12  years  of  age.  The  mentality  of 
io,ooo  white  men  at  Camp  Travis  who  harbored  the  d^feaL 
was  about  33  per  cent  below  normal.  Negroes  were  infc^.^ 
quite  as  frequently  as  whites,  but  they  appea^^^d  toTreuS 
mmune  to  the  serious  effects  of  the  disease  and  m  not  show 

*  mrjiir"'~""°" '°  °''" ''""" "' ''' »-  "^"*" 

in'  Qu'Jinlla^f  a'  ?  "^'^'u  """''  ""°"«  ^  ^°°'  ^^'-Iren 
rL:I>?  . '  ^"''"''"'  showed  that  there  was  an  average 
retardation  of  approximately  two  years  among  heavily  taftSfd 

t   rmrda^c^i  '"T  "'  ^'^""^  Persisted^he  grLT/'^s 

were"ta1cen"^„!^  Th"^''  ?^  ninety-nine  highly  infected  soldier, 
were  taken  upon  their  entrance  to  the  army,  and  again  at  the 

wTriz^'  f  T.j''"'*!?"^'  ''^'^-"'-  of  th-e-ldi*: 

were  treated  for  hookworm  disease,  and  the  other  thirty  re- 
mined  without  treatment.  Those  who  were  treated  ^^ 
«n  average  of  ia6  pounds  in  a  period  of  one  year-  Aosf  w^ 
were  not,  an  average  of  only  ,.,  pounds  "'"' 

"In  Costa  Rica  sixty-six  laborers  before  being  treated  for 
hookworm    disease    normally    cultivated    s6i    IcrW^       I 
n.onA,y.    After  being  treated  for  hoo^o™  di^i  they'^!^ 
vat^  7SO  acres,  resulting  in  a  net  monthly  increase  i7wt^ 

^it^„r  T'  '""  ""°'^"«  f°'  '^  '5  per  cent  redurtio^^ 
unit  pay.     Moreover,  m  India.  Clayton  Lane  reports  that  th^ 


§ 


280       HEALTH  AND  SOCIAL  PROGRESS 

the  laborers  were  treated;  while  reports  from  British  Guiana 
indicate  that  the  efficiency  of  the  laborers  employed  by  one 
company  increased  from  25  to  50  per  cent  after  hookworm 
measures  were  put  into  operation.*' 

FOREIGN  COUNTRISS 

In  Brazil,  the  Federal  and  six  State  govcnuncnts  made 
approximately  $750,000  available  for  hookworm  con- 
trol  alone  in  1918. 

In  India,  the  percentage  of  infection  among  the  runil 
population  often  ranges  from  80  to  100.  In  the  province 
of  Bengal  alone  30,000,000  of  the  45,000,000  population 
are  infected.  From  this  country  the  infection  is  carried 
to  many  parts  of  the  world  by  coolies  and  travelers.  The 
government  has  at  last  recognized  the  economic  im- 
portance of  the  disease  and  has  entered  into  an  arrange- 
ment of  cooperation  with  the  International  Health  Board 
for  carrying  out  a  demonstration  in  control  measures 
in  the  province  of  Madras. 

In  Ceylon  many  communities  and  plantations  are  now 
engaged  in  stamping  out  the  disease,  and  are  paying  more 
attention  to  sanitation  and  hygiene. 

Other  countries  in  which  work  is  done  for  the  elimina- 
tion of  hookworm  disease  are:  Siam,  China,  Java  (with 
an  average  infection  of  93  per  cent),  Guam,  Jamaica,  and 
practically  all  of  the  other  parts  of  the  West  Indies, 
all  of  the  Central  American  States,  the  Fiji  Islands, 
the  SeycheUes,  and  Papua.  In  1917,  Jamaica  ap- 
propriated $12,000  and  Papua  $5,000  for  this  pur- 
pose. 

It  is  most  fortunate  that  the  International  Health  Board 
has  taken  up  the  eradication  of  malaria  in  connection  with 
that  of  hookworm,  since  in  most  tropical  and  sub-tropical 
countries  and  further  north,  the  two  diseases  go  hand  io 


RESULTS  AND  PROSPECTS     281 

hand,  infesting  the  same  persons  either  simultaneously  or 
successively. 

OTHER  DISEASES 

The  practical  elimination  of  yellow  fever,  except  in  a 
few  breeding-places,  needs  only  to  be  mentioned.  Ty- 
phoid fever  is  likewise  nearly  extinct  where  control  is 
complete ;  e.g,,  in  the  United  States  army  and  navy.  For 
less  controlled  populations,  the  results  are  at  least  en- 
couraging. Virginia  reduced  its  morbidity  rate  from  this 
disease  from  14,400  in  1909  to  5,038  in  1917. 

Among  the  poor  people  represented  by  the  Industrial 
Department  of  the  Metropolitan  Life  Insurance  Com- 
pany, the  death  rate  from  tuberculosis  was  reduced  from 
203.0  in  1911  to  172.8  in  1916  per  100,000. 

Wherever  scientific  study  has  been  applied  to  diseases, 
a  diminution  of  mortality  and  morbidity  rates  has  re- 
sulted, irrespective  whether  it  is  done  in  the  forest  jungles 
of  Brazil  or  in  the  steel  mills  of  Pittsburg.  The  United 
States  Steel  Corporation  spends  vast  sums  of  money  on 
welfare  work,  chiefly  for  the  improvement  of  health.  The 
Illinois  Steel  Corporation  finds  it  economically  profitable 
to  spend  $1,000,000  a  year  in  the  protection  of  its  work- 
ingmen  against  disease  and  accidents. 

The  Metropolitan  Insurance  Company  voted  $100,000 
to  the  National  Tuberculosis  Society  a  few  years  ago  to 
establish  a  "  health  town  "  and  the  result  is  reported  by 
American  Medicine  for  November,  1919,  as  follows: 
"When  level-headed  insurance  directors  spend  such  a 
large  sum  of  their  company's  money,  they  naturally  ex- 
pect it  to  bear  interest,  however  indirectly  it  may  be. 
Framingham,  Mass.,  was  chosen  for  the  experiment.  The 
leading  spirits  of  the  town,  level-headed  business  men, 
saw  a  good  opportunity  for  investing  the  town's  money,' 


282      HEALTH  AND  SOCIAL  PROGRESS 

and  raised  the  per  capita  expenditure  for  public  health 
from  39  cents  to  $L00.  The  purpose  of  this  ex- 
periment was  to  show  that  in  many  cases  sickness  and 
death,  particularly  tuberculosis,  can  be  eliminated  by 
medical  treatment  and  careful  nursing,  personal  hygiene 
and  adequate  health  administration.  The  experiment 
proved  an  unqualified  success.  In  1916  before  the  ex- 
periment was  begun,  81  babies  per  1,000  died;  dur- 
ing the  first  year  of  the  experiment  this  was  promptly 
reduced  to  61  per  1,000.  Previous  to  the  inauguration 
of  health  conditions  in  this  town  of  16,000  souls,  121 
persons  died  in  one  year  from  tuberculosis.  In  the  first 
year  of  the  test  this  was  reduced  to  99  deaths,  in  the 
second  year  to  79,  in  the  third  year  to  76— and  this  reduc- 
tion occurred  while  the  town  increased  in  population.  At 
the  end  of  three  years  the  town  leaders  were  well  satisfied 
that  their  investment  of  61  cents  excess  tax  for  health 
was  an  exceedingly  profitable  one.  The  directors  of  the 
insurance  company  felt  that  their  $100,000  experiment 
was  beginning  to  pay  them  better  than  if  it  had  been 
sunk  in  first  mortgages.  Health  towns,  it  was  discov- 
ered, paid.  The  health  of  babies  and  adults  was  actually 
an  "  asset,"  which  could  be  measured  in  dollars  and  cents. 
We  beg  the  indulgence  of  legislators  for  our  carelessness 
in  overlooking  these  facts  and  for  sentimentally  regard- 
ing the  health  of  babies  and  adults  merely  from  a  humane 
point  of  view." 

Much  more  needs  to  be  done.  If  private  corporations 
find  such  large  expenditures  for  health  profitable,  the 
country  as  a  whole  will  do  so,  too;  indeed,  the  world 
as  a  whole  will.  For,  the  world  as  a  whole  is  concerned 
in  this  matter,  not  excepting  our  own  country.  While 
this  treatise  has  been  concerned  chiefly  with  two  endemic 
diseases  prevalent  in  southern  latitudes  there  is  no  special 


RESULTS  AND  PROSPECTS 


283 


reason  why  we  should  be  in  an  exultant  mood.  Our 
country  received  a  rude  shock  when  we  learned  in  1917 
that  out  of  about  1,300,000  volunteers  for  the  army  and 
navy  only  448,859  were  physically  qualified,  the  rejections 
being  66  per  cent.  Some  of  these  were  later  drafted; 
but  even  if  50  per  cent  of  our  young  men  should  be  found 
physically  unfit  for  military  service,  the  percentage  would 
be  uncomfortably  high.  These  figures  were  later  reduced, 
as  will  be  shown.  It  was,  perhaps,  this  revelation  which 
started  several  new  movements  for  improving  the  health 
of  mankind,  chiefly  that  of  the  Red  Cross. 


PROSPECTS 

The  International  Health  Board  is  planning  to  extend 
its  activities  during  1919.  In  addition  to  its  work  against 
yellow  fever,  hookworm,  and  malaria,  the  Board  will  in- 
clude tuberculosis  in  France,  for  all  of  which  an  appro- 
priation of  $2,367,130  has  been  made.  Medical  education 
will  receive  $3,726,504,  part  of  which  will  be  spent  in 
China,  and  the  Medical  School  of  Johns  Hopkins  Uni- 
versity has  received  an  endowment  of  $10,000,000  from 
Mr.  Rockefeller  for  the  study  of  prophylactic  medicine. 
Work  against  hookworm  and  malaria  will  be  done  in 
twelve  Southern  States  and  in  twenty-one  foreign  coun- 
tries. 

During  the  draft  of  1917  and  1918  about  3,208,000 
men  were  examined,  of  whom  521,606  or  16.25  per  cent 
were  utterly  unfit  for  any  military  service  whatsoever. 
A  comparison  of  the  age  groups  of  registrants  showed 
that  76.89  per  cent  of  those  aged  21  were  physically  fit, 
and  of  the  age  group  between  21-30  only  69.17  per  cent 
were  fit.  Of  such  a  select  group  of  men  as  college  students 
are  supposed  to  be,  one  in  every  four  was  physically  dia* 


284      HEALTH  AND  SOCIAL  PROGRESS 
qualified  for  full  military  duty.    The  obviously  unfit  and 
many  others  who  had  dependents  were,  of  IZ!  ^t 
«cam.ned,  and  the  statement  made  previouslyXr^b^ 

qualify  for  fuU  mUitary  service,  seems  to  be  aooroxi 
mately  true,  especially  since  nothing  is  said  rbouftC 

lact  that  the  Federal  Government  has  been  forced  f„ 
face  the  situation  of  a  large  amount  of  ill  hLl  S  L  Jj 
country,  especially  among  the  men  who  should  be  ^s 
vgorous.  Perhaps  millions  of  men  with  remtl^ht 
diseases  will  be  restored  to  health,  and  oti  r  m^E^S 
be  kept  m  good  health  by  the  introduction  of  proZ  aS 

zt:::::^  r  ""'•'*=  »•-'*  ^^^-  whKe^'S! . 

tary  strength  of  a  country  is  at  stake,  the  government 
usually  acts  just  as  the  English  Parliament  aSed  ™ 
similar  revelation  during  the  Boer  War 

fnJl^S^'^u'T!^  '*  inaugurating  a  world-wide  movement 
for  public  health.  An  International  Committee  of Td 
Cross  Societies  was  organized  in  April.  1919  with  th. 
for«„ost  specialists  of  the  medical  and  sanitarl     * 

united  btates,  as  members.     RepresentativAc  r.f     *u 
countries  will  be  elected  as  soon  Z^Z     t^Z 
IS  to  have  a  central  office  in  Geneva.  Switzerland  whkh 
s  to  serve  as  a  clearing  house  on  all  matters  of  healtJ^anl 
sanitation.    Any  „ew  discovery  in  curative  or  pr^*  «ve 
medicine  will  be  communicated  to  this  office  and XmT 
nated  from  there  all  over  the  world.    Anything  £  c^n 
tnbutory  to   health   will   receive   the  doselt   ».ll  T' 
since  the  work  is  to  be  prophylact.^  ttr  T^ 

methods.     The   results  to  be  attained  a.,  'briefly  t 


RESULTS  AND  PROSPECTS 


285 


First — Owing  to  the  close  international  relations 
through  commerce  and  migration,  diseases  are  now 
spread  from  some  obscure  corner  of  the  world  to  other 
countries.  The  work  proposed  would  arouse  the  peoples 
of  every  country  to  a  sense  of  their  obligation  to  their 
fellowmen,  and  there  would  naturally  follow  in  each 
country  an  awakening  to  the  needs  within  its  own 
borders,  and  a  determination  to  meet  them  as  far  as 
possible. 

Second — It  would  throw  light  on  the  darkest  comers  of 
the  earth,  and  would  give  to  all  the  world  the  full  benefit 
of  scientific  study  and  experience  in  the  cure  and  pre- 
vention of  disease. 

Third — It  would  make  possible  the  immediate  coopera- 
tion on  the  part  of  various  organizations  to  render  aid 
when  necessary  in  the  case  of  great  disasters. 

If  such  an  organization  had  been  operative  in  1917 
it  is  probable  that  the  influenza  epidemic  could  have 
been  confined  to  its  source  in  China,  that  several 
millions  of  lives  would  have  been  saved,  thousands  of 
others  would  have  been  spared  its  weakening  effects,  and 
untold  misery  prevented. 


Whatever  aspect  of  health  is  considered,  it  has  an  im- 
portant bearing  on  social  progress.  The  men  of  genius 
who  have  given  to  the  world  the  vital  ideas  which  have 
made  civilization  possible,  were  healthy  men.  Progres- 
sive nations  could  live  only  in  regions  which  permitted 
at  least  a  fair  amount  of  health.  The  increasingly  greater 
need  for  food  will  compel  the  nations  of  the  north  to 
make  the  countries  of  the  south  sanitary.  The  many 
serious  ailments  from  which  society  suffers,  will  be 
largely  alleviated,  if  not  removed,  by  greater  attention 


286       HEALTH  AND  SOCIAL  PROGRESS 

to  health.  It  is  within  human  power  to  turn  our  social 
destiny  by  more  diligent  application  of  scientific  dis- 
coveries already  made  and  others  soon  to  come,  into 
paths  of  health  and  happiness.  A  gift  of  $50,000,000 
was  announced  January  1,  1920,  by  Mr.  Rockefeller 
for  the  scientific  extension  of  work  on  health  all  over 
the  world.  This  will  enable  mankind  to  apply  the 
medical  discoveries  already  made  more  widely,  and  to 
pursue  the  search  for  health  more  generally.  A  new 
era  is  thus  dawning  in  which  health  will  be  considered 
one  of  the  most  important  assets  of  society. 


i\ 


I 


, 


NOTES 

Explanation:  The  notes  throughout  the  book  are  numbered 
consecutively.    The  numbers  have  no  reference  to  pages. 

^Influence  of  Geographic  Environment,  by  Ellen  C.  Semple; 
Henry  Holt  &  Co.,  New  York,  191 1,  p.  2. 

^The  Efficient  Ufe,  by  Luther  H.  GuHck.  M.D.;  Doubleday. 
Page  &  Co.,  New  York,  1907;  pp.  177  and  178. 

«  Secret  of  Hegel,  by  J.  Stirling,  Vol.  H,  p.  554. 

*The  Play  of  Animals,  by  Karl  Groos;  D.  Appleton  &  Co., 
New  York,  1898. 

^Inductive  Sociology,  by  F.  H.  Giddings,  p.  252. 

*The  Aristocracy  of  Health,  by  Mary  Foote  Henderson; 
Harper  &  Brothers,  New  York,  1906;  p.  6. 

"^Inductive  Sociology,  by  F.  H.  Giddings;  pp.  257  and  259. 

*  Hereditary  Genius.  Macmillan  &  Co.,  London  and  New 
York,  1892;  p.  271. 

•  See  Dr.  H.  K.  Carroll's  article  in  the  New  York  Christian 
Advocate,  January  30,  1913,  on  "Statistics  of  the  Churches  of 
the  United  States — 1912." 

10  Body  and  Mind,  by  Henry  Maudsley,  M.D. ;  D.  Appleton  & 
Co.,  New  York,  1884;  pp.  no  and  iii. 
^^ Growth  of  the  Brain,  by  Henry  Herbert  Donaldson;  Chap. 

^*  Maudsley,  op,  cit.,  p.  38. 

^* Pure  Sociology,  by  L  F.  Ward;  pp.  267-272. 

^^  Politics,  Book  I,  Chap.  VL 

^^  Inductive  Sociology,  p.  252. 

^*The  Theory  of  the  Leisure  Class,  by  Thorstein  Veblen; 
The  Macmillan  Co.,  New  York,  1908;  p.  15. 

*^  Inductive  Sociology,  pp.  259  and  260. 

"/<  Practical  Study  of  Malaria,  by  Wm.  H.  Dcaderick,  M.D.; 
W.  B.  Saunders  Co.,  Philadelphia  and  London,  1909;  pp.  17 
and  19. 

^•Tropical  Diseases,  by  Sir  Patrick  Manson;  Wm.  Wood  & 
Co.,  New  York;  p.  68. 

*•  Ibid.,  p.  70. 

»i  Ibid.,  p.  70. 

*^Ibid.,  p.  72. 

25  Deaderick,  op.  cit,  p.  ^37. 

2*  Ibid.,  pp.  29^-297- 

"  Ibid.,  p.  298. 

*•  Manson,  op.  cit.,  p.  1091 

^"^  Ibid.,  p.  no. 

^*  Malaria:  A  Neglected  Factor  in  the  History  of  Greece  emd 
Rome,  by  W-  H.  S.  Jones,  M.A.;  "Introduction**  by  Major  R. 

a87 


'& 


■ffir 


288 


NOTES 


Ross,  F.R.S.;  "Concluding  Chapter"  by  G.  G.  Ellctt,  M.B.; 
Macmillan  &  Bowes,  Cambridge,  England,  1907;  p.  7. 

2»  Manson,  op.  cit.,  p.  102. 

•oDcaderick,  op.  cit,  pp.  31-33. 

•iDeaderick,  op.  cit.,  pp.  22  and  23. 

^Influences  of  Geographic  Environment,  by  Ellen  C.  Semple; 
Henry  Holt  &  Co.,  New  York,  1911;  pp.  no  and  in. 

^^  Hereditary  Genius,  by  Francis  Galton,  F.R.S. ;  Macmillan 
&  Co^  London  and  New  York,  1892;  p.  329. 

•*  Galton,  ibid.,  p.  331. 

••Jones,  Malaria  and  Greek  History,  pp.  15  and  16. 

5«  Major  Ross,  in  Jones,  Malaria,  p.  4. 

87  Handbook  of  American  Indians.  Bulletin  30  of  Bureau  of 
American  Ethnology,  Washington,  D.  C,  1910,  Part  II,  p.  286. 

^^Sociological  Papers,  London,  1904;  article  "Eugenics:  Its 
Definition,  Scope  and  Aims." 

^*  Malaria  and  Greek  History,  by  W.  H.  S.  Jones,  M.A., 
University  Press,  Manchester,  1909;  pp.  12  and  13. 

*®  Jones,  Malaria,  p.  11. 

*i  Lectures  on  Tropical  Diseases,  by  Sir  Patrick  Manson,  M.D. ; 
W.  T.  Keener  &  Co.,  Chicago,  1905;  pp.  103  and  104. 

*2Ross,  in  Jones,  Malaria^  p.  7. 

«  Deaderick,  op.  cit.,  p.  20. 

**  Tropical  Diseases,  p.  i. 

*•  Report  on  the  Prevention  of  Malaria  in  Mauritius,  p.  51 ; 
quoted  by  Jones  in  Malaria  and  Greek  History,  p.  vi. 

*«  Malaria  and  Greek  History,  p.  23. 

^"^  Ibid.,  p.  27. 

^^Ibid.,  p.  34. 

«/6id.,  p.  16. 

»<>  Ellett,  in  Jones,  Malaria,  pp.  94*^ 

^^  Malaria  and  Greek  History,  p.  55. 

« Ibid.,  p.  97. 

•3  Ibid,  p.  102. 

•*  Jones,  Malaria,  pp.  95  and  96. 

»5  Deaderick,  op.  cit.,  pp.  28  and  29. 

^^  Malaria  and  Greek  History,  p.  11. 

•^  Jones,  Malaria,  p.  41. 

^^  Encyclopedia  Britannica,  nth  ed..  Vol  XVI,  article  Latium. 

••Jones,  Malaria,  p.  66. 

•o/Wd.,  p.  85. 

•1  The  Effects  of  Tropical  Light  on  White  Men,  by  Major 
Charles  E.  Woodruff;  Rebman  Company,  New  York,  1905; 
p.  224. 

^^Ibid.,  p.  239. 

*^  Encyclopcedia  Britannica,  nth  cd..  Vol.  XVIII,  p.  915;  article 
"  Mauritius." 

^Malaria  and  Greek  History,  p.  48. 

*^What  Have  the  Greeks  Done  J  or  Modem  Civilisation  f  by 
John  P.  Mahaffy;  G.  P.  Putnam's  Son,  New  Yprk,  1909;  p.  209. 


NOTES 


289 


•«  The  Races  of  Europe,  by  William  Z.  Ripley ;  D.  Appleton  & 
Co.,  New  York,  1899;  p.  259. 

•^  The  Effects  of  Tropical  Light  on  White  Men,  by  Major 
Charles  E.  Woodruff ;  Rebman  Company,  New  York,  1905. 

«8  The  Hookworm  Disease,  by  George  Dock,  M.D.,  and  Charles 
C.  Bass,  M.D. ;  C.  V.  Mosby  Co.,  St.  Louis,  1910;  pp.  19-32. 

«•  Rockefeller  Sanitary  Commission  for  the  Eradication  of 
Hookworn  Disease;  Washington,  D.  C,  191 1;  Publication  No.  6, 
pp.  26  and  27. 

^0  Rockefeller  Sanitary  Commission,  etc.,  191 1 ;  Publication  No. 
5,  p.  II. 

'^  Dock,  Hookworm  Disease,  p.  183. 

72  Hygienic  Laboratory,  Bulletin  No.  10,  Washington,  D.  C, 
February,  1903,  p.  45  ("Prevalence  and  Geographic  Distribu- 
tion of  Hookworm  Disease  in  the  U.  S.,"  by  Charles  Wardell 
Stiles,  M.D.). 

73  Uncinariasis  (Hookworm  Disease)  in  Porto  Rico,  by  Bailey 
R.  Ash  ford,  M.D.,  and  Fedro  Gutierrez  Igaravidez,  M.D.  Senate 
Document  No.  808,  61.  Congress,  Washington,  191 1;  pp.  89 
and  90. 

7*  Rockefeller  Sanitary  Commission,  etc.  Publication  No.  6, 
p.  7?. 

»•  Rockefeller  Sanitary  Commission,  etc.  Publication  No.  6, 
p.  7. 

7«  Rockefeller  Sanitary  Commission,  etc.  Publication  No.  5, 
pp.  120  and  121. 

T»  Rockefeller  Commission,  etc  Publication  No.  5,  pp.  113- 
126. 

78  Dock,  op.  cit.,  p.  97. 

7»Ashford,  op.  cit.,  p.  4. 

•oAshford,  op.  cit.,  p.  6. 

•^  Ash  ford,  op.  cit.,  p.  7. 

•2  Ash  ford,  op.  cit.,  p.  11. 

•8  Anemia  in  Porto  Rico,  Preliminary  Report,  1905,  p.  25. 

^*  Report  of  the  Governor  of  Porto  Rico  for  1013:  statistics 
on  pages  145  to  152. 

85  Annual  Report  of  the  Department  of  Health  of  the  Isthmian 
Canal  Commission  for  igo6,  pp.  4  and  5. 

8«Ashford,  op.  cit.,  p.  205. 

^^ History  of  Philosophy,  by  Alfred  Weber;  Charles  Scribner's 
Sons,  New  York,  1896;  pp.  519  and  520, 

88  The  Mind  of  Primitive  Man,  by  Franz  Boas ;  the  Macmillan 
Company,  New  York,  I9n  ;  pp.  16  and  17. 

8»  Influence  of  Geographic  Environment  on  the  Basis  of  Ratsel's 
^ystem  of  Anthropo-Geography,  by  Ellen  Churchill  Semple; 
Heni7  Holt  &  Co.,  New  York,  ipn ;  p.  40. 

, .  *?  Rockefeller  Sanitary  Commission,  Publication  No.  S ;  "  Ex- 
hibits. Photographs."  Figures  2.  7  and  8. 

^^  Influences   of   Geographic  Environment,  etc.,   p.   42. 

w  Oscar  Peschel,  The  Races  of  Man;  Appleton  &  Co.,  New 


290 


NOTES 


York,  1868;  p.  «7.  pages  308  to  318,  discussing  "The  Zone  of 
the  Founders  of  Religion." 

J^^Sociaf  Evolution,  by  F.  Stuart  Chapin;  The  Century  Co., 
New  York,  1913 ;  pp.  160  and  165.  '         * 

AT^^r^nJ^"*^.^^*^^'^^*'^  *^  £«y/aiid,  by  H.  T.  Buckle. 
Vol,  I,  Chapter  II;  London,  1857-1861.  ^  ^  ^ 

••Ashford,  op.  cit.,  p.  7. 

**R"°>5*'^T^*'LY/"^?"l  Jhompson,   M.D.,  in  Brain  and  Per- 
^^^i!}!   vI^o<l,l  ^lead  &  Co..  New  York.  1910;  p.  51. 
^'\^  Growth  of  the  Broin    by  Henry  Herbert  Donaldson; 
Charles  Scnbner's  Sons,  New  York,  1897;  p.  352. 

»«  Boas,  op.  cit.,  p.  24, 

^""The  Effects  of  Tropical  Light  on  White  Men,  by  Major 
Charles  E.  WoodruflF,  M.D. ;  Rebman  Co.,  New  York  and  Lon- 
don, 1905;  p.  265. 

llr  )l^^^f»ff'  op'  «■'•*  pp.  153  and  154. 
^^^Ibtd.,  p.  158. 

W2  Expansion  of  Races,  by  Charles  E.  WoodruflF,  M.D. :  Reb- 
man Company,  New  York,  1909;  p.  274. 

^^^  The  Military  Surgeon,  August,  1912,  pp.  162  to  166.  "The 
Relative  Resistance  of  Blonds  and  Brunettes  to  the  Harmful 
Influences  of  a  Tropical   Qimate."     See  also   "Tropical   Sun- 

Ipt' V^.  £S  N^o  6""'  "^  ^^^-^^^  ^^''"^^  ^^"^^'^^  J"-' 

io«  ivitaf  Have  *f^  Greeks  Done  for  Modem  Civiligationf  by 
John  Pentland  MahaflFy ;  G.  P.  Putnam's  Sons,  New  York,  1909 ; 

lol  S^  5^'f  ^  ^•'''^^l'  KY^'  Z.  Ripley,  pp.  407  and  408. 

10*  Weather  Influences,  by  Edwin  Grant  Dexter,  Ph.  D. ;  The 
Macmillan  Company,  New  York,  1904-  p   75 
^^^  The   Races   of  Mtin:    An   Outline  of '  Anthropology  and 
Ethnography,  by  /.   Deniker,   ScD.;    Charles   Scnbner's   Sons, 
New  York,  1907;  p.  145. 

«rVt!£"t^'''?fu*'*  cu"^"''Jf'''w"iJ**   «^»^»°"'  ^•^icle  "Malaria," 
written  by  Arthur  Shadwell,  M.D.,  and  Harriet  L.  Hennessey. 

"»  Semple,  op.  cit.,  p.  626. 

*"  Semple,  op.  cit.,  pp.  560  and  561. 

Ma^arta,  by  Graham  E.  Henson,  M.D. ;  C.  V.  Mosby  Com- 
pany, St.  Louis,  1913 ;  p.  25. 

J"  Report  on  National  Vitality,  by  Irving  Fisher ;  Washington, 
Government  Prmtmg  Office,  1909;  p.  16 

^^J Municipal    Government,    bv    Frank    J.    Goodnow,    Ph.D.; 

tf.£?*Hn^  .9®™Pany,  New  York,  1909:  p.  25. 
^nno.         CAo/fcnye  of  the  City,  by  Josiah  Strong;  New  York, 
1909 »   P»    lo. 

rHU^P"^*  ?f  .*^^ J>fp(irtment  of  Sanitation  of  the  Isthmian 
{.anal  Commtsston  for  igu;  Washington,  1913;  pp.  5,  6  and  7. 


NOTES 


291 


^^*  Encyclopedia  Britannica,  nth  ed,  Vol.  XVII,  pp.  464-s; 
article  "  Malaria."  yy    -^^^ 

^^^  Encyclopcedia  Britannica,  nth  ed.,  Vol.  XV,  p.  13,  article 
"  Italy,"  section  "  Malaria." 

12®  The  Isthmian  Canal,  by  H.  H.  Rousseau ;  Washington, 
Government  Printing  Press,  1910;  p.  45. 

121  The  Popular  Science  Monthly,  September,  1913,  Vol. 
LXXXIII,  No.  3,  p.  298.  (This  magazine  has  changed  its  title 
to  "The  Scientific  Monthlv,"  and  should  not  be  confused  with 
the  Popular  Science  Monthly  of  to-day.) 

"2  The  Survey  October  5,  1912.  Vol.  XXIX,  No.  i,  p.  47. 

^'*  Health  and  Longevity  Through  Rational  Diet,  by  Dr. 
Arnold  Lorand;  F.  A.  Davis  Company,  Philadelphia,  Pa.,  1913; 
pp.  7  and  8. 

12*  Lorand,  ibid.,  p.  7. 

"» Woodruff,  Effects  of  Tropical  Light  on  White  Men,  pp. 
345  and  346. 

i*«  Woodruff,  Expansion  of  Races,  pp.  309  and  310. 

^^'f  Expansion  of  Races,  2.  309. 

«» Walter  H.  Page,  "The  Hookworm  and  Civilization,"  in 
The  World's  Work,  September,  1912. 

"•  "  The  Sanitary  Awakening  of  a  Nation,"  Presidential  Ad- 
dress by  Charles  P.  Wertenbaker,  United  States  Public  Health 
Service,  The  Military  Surgeon,  November,  1912,  pp.  491  and  492. 

^^^The  Insanity  of  Genius,  by  J.  F.  Nisbet;  New  York, 
Charles  Scribncr's  Sons,  6th  ed.,  1912,  p.  1S4. 

^^^  Biographic  Clinics,  by  George  M.  Gould,  M.D.;  F.  Blakis- 
ton's  Son  &  Co.,  Philadelphia;  3  vol.,  1903,  1904  and  1905. 

^^^  Life  and  Letters,  p.  107. 

"•Weber,  History  of  Philosophy,  p.  435. 

*»*  Ktmo  Fischer,  Hegel,  Vol.  1,  p.  214. 

i«»  Nisbet,  of.  cit.,  pp.  271  and  272. 

"«  The  Prolongation  of  Life,  by  Elie  MetchnikoflF;  G.  P.  Put- 
nam's Sons,  New  York,  1906;  p.  261. 

*«^  The  Man  of  Genius,  by  Cesare  Lombroso ;  Charles  Scrib- 
ner's  Sons,  New  York,  1908;  pp.  354-356. 

"•  "  The  Physical  Beethoven,"  in  the  Popular  Science  Monthly, 
March,   1914. 

"•  "  The  Intellectual  and  the  Physical  Life,"  Popular  Science 
Monthly,  July,  1913. 

^*^  Social  and  Ethical  Interfretations  in  Mental  Development, 
by  James  Mark  Baldwin;  Macmillan  Company,  New  York, 
2nd  ed.,  1899;  p.  168. 

"lP"o*cd  from  The  City  of  the  Sun,  by  Lombroso,  op.  cU., 
p.  288. 

**2  Rogers,  Popular  Science  Monthly,  July,  1913 ;  p.  55. 
^*^  Pedagogical  Anthropology,  by  Maria  Montessori ;  Frederick 
Stokes  Company,  New  York,  191 3 ;  p.  469. 
***  Lombroso,  op.  cit.,  p.  353. 


t 


INDEX 


Actinic  ray  theory  of  Wood- 
ruff, 114,  142,  169 

Adenoids,  25 

Alexandria,  culture  of,  due  to 
health  fulness,  118 

Altitude  and  health,  190 

Altruism,  30 

Anophelines,  carriers  of  ma- 
laria, 98 

Biology     and     health     better- 
ment, 9 
Brain,  development  of,  27 
Brain  weight,  166 

Cephalic  indexes,  167 
Christianity,  ideals  of,  36 
Church  attendance,  yj 
Cities,  health,  209;  growth,  212 
Classical  world,  effects   of   ill 

health  upon,  11 1 
Climate,  44,  I54 
Crime,  explanation  of,  50 

Dcaderick,  William  H.,  83 
Diet,  in  relation  to  energy,  222 
Disease,  meaning  of,  20 

Egjrpt,  endenvc  diseases  ex- 
plain rule  by  foreigners,  204 

Endemics,  14,  192 

Energy,  19;  diverted  by  bodily 
disorders,  25 

Epidemics,  14 

Eugenics,  9 

Food,  23 ;  variety  of  necessary, 
222;  zones  of  production, 
276 


Freedom,  relation  of  health  to. 
189 

Geophagy  (dirt-eating),  176 

Genius,  origin,  241 ;  defined, 
242;  relation  to  health,  245; 
originality,  256 

Golden  Rule,  the,  35 

Greece,  malaria  probable  ex- 
planation of  deterioration  of, 
8,  100 

Health,  defined,  15 ;  factors  of, 
43 

Health  department,  need  for 
national,  239 

Health  habits  of  ancient  races, 
7 

Hegelian  theory  of  progress, 
143  . 

Heredity  and  health,  44 

Hindoos,   superstitions  of,   153 

Hookworm  disease,  geographi- 
cal distribution  of,  124; 
physical  effects,  128;  mental, 
129;  moral,  130;  economic 
and  social,  131 ;  on  Porto 
Rican  coffee  and  sugar 
plantations,  136;  statistics  of 
mental  retardation  caused 
hy,  279;  governmental  aid 
for  control  of,  280 

Housing,  213 

Hygiene,  prophylactic  work  of, 
9 

Ideals,  national,  59 
Industry  and  health,  10 
Infant    mortality,    reduced    by 

municipal    health    measures. 

282 
Influenza,  285 
Instinct,  46 


993 


«94 


INDEX 


International     Health     Board, 

283 
International  law,  origin  of,  55 
Internationalism,     of     science, 

commerce  and  politics,  235 

Leisure.  53 

Light  and  racial  development, 
"4 

Malaria,  83;  geographical  dis- 
tribution   of,    ^;    types    of, 
85;    disseminated    by    mos- 
quitos,  91 ;    effects   of,    122 ; 
extirpation  of,  213 
Malnutrition  and  morality,   51 
Mentality  and  health,  26,  41 
Migrations,  motives  for,  199 
Morality  and  sociali^,  30,  39 
Mosquitos,  carriers  of  malaria, 
91 ;  yellow  fever,  174 

Nature-peoples,  14,  43,  64 
Nerves,  20 
Nutrition,  26 

Objectivity,   test   of   sanity   in 
genius,  257 

Pain,  explanation  of,  20 
Parasites,     factor     in     man's 

struggle  for  existence,  3 
Patent    medicines,    psychology 

of,  184 
Persecutions,      explained      on 

basis  of  health,  191 
Peschel,  theory  of  influence  of 

environment      on      religion, 

151 
Pessimism,    in    subjective   gt- 

ius,  265 
Philanthropy  and  the  church. 

Physical  economy,  23 
Pigmentation,  protective,  167 
Play.  24 
Population,     world's     increase 

of,  218 
Porto  Rico,  hookworm  disease 

in,  133 ;  malaria  in,  137 


Progress,  five  laws  of,  77 
Progress,  theories  of,  143; 
transcendental,  142 ;  his- 
torical or  accidental,  144; 
natural  or  geographical,  145 ; 
anthropological,  166;  actinic 
ray,  167;  explained  on  basis 
of  health,  178;  continuity 
and   extension   of    essential, 

193 
Prophylaxis  vs.  cure,  40 
Psychology  and  health  better- 
ment, 9 

Ratzel-Semple  theory  of  prog- 
ress, 145 

Red  Cross,  international  health 
movement,  284 

Reed,  discoverer  of  yellow 
fever   mosquito,   174 

Religion  and  physical  environ- 
ment, 151 

Religions,  ideals  of,  33,  36 

Revolutions,  why  frequent  in 
tropics,  186 

Rockefeller,  John  D.,  gift  for 
extension  of  health  work, 
286 

Rockefeller  Sanitary  G)mmis- 
sion,  277 

Rome,  malaria  introduced  into, 
106 

Ross,  discoveries  in  malaria,  85 

Sanitation,  in  tropical  coun- 
tries, 213;  conducted  by  pri- 
vate enterprises,  273 

Sanity,  three  tests  of,  257 

Sciences  and  health,  8 

Sickness,  racial,  28 

Social  nature,  the,  75 

Sociality,  51 

Sociology,  concerned  with 
health,  9 

Spiritual  importance  of  health, 
8 

Stegomyia  (yellow  fever  mos- 
quito), 174 

Strain,  physical  and  mental,  243 


INDEX 


295 


Superstitions,  origin  of,  185 

Tropics,  health  conditions,  124 ; 

causes  of  moral  laxity,  154; 

sanitation,   213;   government 

in,  229 
Transcendental       theory       of 

progress,  142 

Uncinariasis  (hookworm  dis- 
ease), 124  ff. 

United  Fruit  Company,  sani- 
tation conducted  by,  273 


Utility,     test     of     sanity 
genius,  257,  263 


in 


Vital  statistics  of  modern 
countries,  206;  increasing 
span  of  life,  237 

Vitality,  17;  necessary  for  so- 
cial action,  29 

Work,    factor    in    civilization, 

,  65 

Woodruff,  actinic  ray  theory, 
167 


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